Medicare AdvantagePrior AuthMedium impact
Rezurock (belumosudil) (Revised)
Humana·Hematology, Oncology, Pharmacy·Medicare Advantage
Effective date
Sep 24, 2025
We identified it
Aug 6, 2026
Summary
Humana Medicare Advantage updated its Rezurock (belumosudil) prior authorization policy effective September 24, 2025. The policy maintains three approval criteria: cGVHD diagnosis, failure of at least two prior systemic therapy lines, and documented medical reason why Jakafi (Ruxolitinib) cannot be used. Claims will be denied if the member experiences disease progression while on Rezurock. Billing teams must ensure prior authorization is obtained before dispensing and document the required clinical criteria.
Action Required
By September 24, 2025: Billing and pharmacy teams must implement prior authorization requirements for all Rezurock (belumosudil) claims under Humana Medicare Advantage plans. Before processing any Rezurock prescription, verify prior authorization is in place by confirming: (1) member has documented cGVHD diagnosis, (2) member has failed at least two prior systemic therapy lines, and (3) provider has documented medical reason why Jakafi (Ruxolitinib) cannot be started or continued. Update pharmacy system and billing software to flag Rezurock for mandatory prior auth review. Train pharmacy and billing staff to deny or hold claims for Rezurock if authorization is not obtained first. Reference Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for current coding requirements. Ensure rejection process includes clear communication to prescribers about missing clinical documentation. Do not process claims for members showing disease progression on Rezurock without escalation to medical director. Claims processed without proper prior authorization will be denied.