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HumanaMedicaid · Prior Auth · Medicaid · IN · Hematology, Oncology, PediatricsMedium impact

Blincyto® (blinatumomab) (Revised)

Act
by Sep 15, 2025
Effective date
Oct 1, 2025
Identified
Jul 21, 2026

Summary

Humana has revised its Blincyto® (blinatumomab) prior authorization policy for Indiana Medicaid, effective October 1, 2025, with updates through July 22, 2026. The policy covers three treatment scenarios: relapsed/refractory B-cell ALL (as monotherapy or with tyrosine kinase inhibitors), MRD-positive B-cell precursor ALL in first/second remission, and consolidation phase treatment. All Blincyto claims require prior authorization approval before administration.

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What to do

by Sep 15, 2025 · 11 steps
01Billing team must implement prior authorization workflow for all Blincyto (blinatumomab) claims for Indiana Medicaid members.
02Verify patient eligibility against three coverage pathways.
03Philadelphia chromosome-negative or positive relapsed/refractory B-cell ALL on monotherapy or with tyrosine kinase inhibitor (bosutinib, dasatinib, imatinib, nilotinib, or ponatinib).
04MRD-positive B-cell precursor ALL in first or second complete remission (≥0.1% MRD level) on monotherapy or with tyrosine kinase inhibitor.
05Consolidation phase multiphase chemotherapy for CD19-positive Philadelphia chromosome-negative B-cell precursor ALL.
06Obtain prior authorization from Humana before infusion.
07Update EMR/billing system to flag all Blincyto infusions as requiring pre-authorization.
08Train clinical staff on baseline bone marrow blast percentage requirements (≥10% for relapsed/refractory; <5% for MRD-positive).
09Provider must document complete remission status and MRD level in clinical notes.
10Claims submitted without prior authorization approval will be denied.
11Approval duration is plan year or as determined through clinical review.

Codes mentioned

J9033

Original notice

Blincyto® (blinatumomab) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related policy hubs

Humana policiesIN policy changesHematologyOncologyPediatricsCode J9033

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