Medicare AdvantagePrior AuthMedium impact
Rezlidhia (olutasidenib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Aug 6, 2026
Summary
Humana Medicare Advantage revised its Rezlidhia (olutasidenib) prior authorization policy on November 26, 2025, for relapsed/refractory acute myeloid leukemia with documented IDH1 mutation. The policy requires prior authorization for monotherapy use, with initial 6-month approval and 6-month renewals. Key clinical requirements include ECOG performance score 0-2, black box warning for differentiation syndrome, and mandatory liver function monitoring.
Action Required
By December 26, 2025: Billing team and oncology providers must update prior authorization workflows to implement Rezlidhia coverage requirements. (1) Create/update prior auth submission templates in billing system to capture: diagnosis of relapsed/refractory AML, documentation of IDH1 mutation status (FDA-approved test), confirmation of monotherapy use, ECOG performance score (0-2), and patient age (18+). (2) Configure system to set initial authorization duration to 6 months with automatic renewal reminders at 5-month mark for 6-month renewals. (3) Train billing staff and providers on exclusion criteria: deny coverage if member has experienced disease progression while on or after Rezlidhia. (4) Add alert to EMR/billing system for clinical monitoring requirements: liver function tests during treatment and hemodynamic monitoring if differentiation syndrome suspected. (5) Update pharmacy benefit coordinator communication templates to include black box warning information. (6) Notify oncology providers to document clinical benefit assessment by month 6 to determine continuation eligibility. Failure to obtain prior authorization will result in claim denials for Rezlidhia prescriptions.