Medicare AdvantagePrior AuthHigh impact
Blincyto® (blinatumomab) (Revised)
Humana·KY, SC · Oncology, Hematology·Medicaid
We identified it
Jul 22, 2026
Summary
Humana has issued a revised Prior Authorization policy for Blincyto® (blinatumomab) affecting Medicare, Medicaid - Kentucky, and Medicaid - South Carolina members. This is a 1-day-old policy update requiring immediate review to ensure billing and clinical teams understand new or modified authorization requirements before submitting claims.
Action Required
IMMEDIATE: Billing team and clinical staff must obtain and review the full policy document from the provided URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867fe) to extract specific prior authorization requirements, effective dates, and any billing code changes for Blincyto® administration. Update prior authorization submission procedures in billing software for all affected states and plans. Notify providers to request prior authorization before administering Blincyto® to affected members. Establish escalation protocol for any claims previously submitted under superseded guidance. Do not process claims without confirming compliance with revised requirements.