Medicare AdvantagePrior AuthMedium impact
Besremi (ropeginterferon alfa-2b-njft) (Revised)
Humana·Hematology, Oncology, Internal Medicine·Medicare Advantage
We identified it
Jul 28, 2026
Summary
This is a revised Prior Authorization policy for Besremi (ropeginterferon alfa-2b-njft), a medication for Medicare Advantage members. The policy update requires prior authorization before dispensing this drug. Billing teams must implement this requirement immediately to prevent claim denials.
Action Required
Immediately: Billing team must update prior authorization workflow to require PA approval before dispensing Besremi (HCPCS J9214) for all Medicare Advantage members. Work with pharmacy staff and prescribers to implement PA submission process at point of service. Coordinate with the Humana Medicare Advantage plan using the source policy URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a58e23f) for PA submission requirements and timelines. Flag any existing claims for Besremi without prior authorization for reprocessing. Claims submitted without required prior authorization will be denied by Humana Medicare Advantage.