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HumanaMedicare Advantage · Prior Auth · Medicaid · KY, SC · Oncology, Hematology, PharmacyMedium impact

Blincyto® (blinatumomab) (Revised)

Effective date
Jan 1, 2020
Identified
Jul 22, 2026

Summary

This is a revised Blincyto (blinatumomab) pharmacy coverage policy for Humana Medicare and Medicaid (Kentucky and South Carolina) that maintains prior authorization requirements for three B-cell acute lymphoblastic leukemia (ALL) indications: relapsed/refractory disease, MRD-positive disease in remission, and consolidation phase treatment. The policy was last revised on July 22, 2026 (2 weeks ago) and includes black box warnings for cytokine release syndrome and neurological toxicities.

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What to do

Action · 5 steps
01Billing team must verify Blincyto claims meet one of three clinical criteria before submission: (1) relapsed/refractory Ph-negative or Ph-positive B-cell ALL as monotherapy or with tyrosine kinase inhibitors; (2) B-cell precursor ALL in first/second remission with MRD ≥0.1% as monotherapy or with tyrosine kinase inhibitors; or (3) B-cell precursor ALL in consolidation phase.
02All Blincyto requests require prior authorization from Humana before dispensing.
03Verify member is enrolled in Medicare or Medicaid (Kentucky or South Carolina only).
04Document clinical indication and disease status in prior auth request.
05Review updated policy at humana.com/PAL for current coding information.
If missed: Failure to obtain prior authorization will result in claim denials.

Codes mentioned

J9033

Original notice

Blincyto® (blinatumomab) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Humana policiesKY policy changesSC policy changesOncologyHematologyPharmacyCode J9033

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