Medicare AdvantagePrior AuthMedium impact
Idhifa® (enasidenib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Aug 6, 2026
Summary
Humana has revised its prior authorization policy for Idhifa (enasidenib) effective October 22, 2025. The policy now covers two distinct AML indications: relapsed/refractory AML with IDH2 mutation and newly diagnosed AML in patients ineligible for intensive induction therapy. Both pathways require IDH2 mutation documentation and prior authorization with 6-month approval/renewal cycles. Key change: newly diagnosed AML coverage is now explicitly included, expanding eligible patient populations.
Action Required
By October 22, 2025: Billing and prior authorization teams must update authorization workflows to recognize TWO approval pathways for Idhifa instead of one: (1) Relapsed/Refractory AML with IDH2 mutation, and (2) Newly Diagnosed AML with comorbidities ineligible for intensive therapy plus IDH2 mutation. Update authorization criteria in billing system to enforce all required criteria for each pathway, including mandatory IDH2 mutation documentation before approval. Verify that disease progression history is captured as an exclusion trigger. Train prior auth staff on the expanded indication and ensure encounter forms/authorization request templates reflect both pathways. Update internal documentation to reflect the October 22, 2025 revision date. Failure to apply correct criteria may result in claim denials or inappropriate approvals.