MedicaidPrior AuthMedium impact
Bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Indiana Medicaid has implemented a new prior authorization policy for bendamustine products (Treanda, Bendeka, Belrapzo, Vivimusta) effective May 1, 2026. The policy establishes specific clinical criteria for coverage across five hematologic malignancies (CLL, Multiple Myeloma, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma, and Waldenström's Macroglobulinemia), with automatic denial for members experiencing disease progression on bendamustine-containing regimens. All bendamustine prescriptions now require prior authorization with approval limited to the plan year or as determined through clinical review.
Action Required
By April 30, 2026: Billing and clinical teams must implement prior authorization process for all bendamustine product claims (Treanda, Bendeka, Belrapzo, Vivimusta) for Indiana Medicaid members. Update billing system to flag all bendamustine prescriptions for prior auth review. Providers must document: (1) specific diagnosis (CLL, Multiple Myeloma, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma subtype, or Waldenström's Macroglobulinemia), (2) treatment line/status (first-line, relapsed, refractory, or progressive disease as applicable per diagnosis), and (3) confirmation of no prior disease progression on bendamustine. Create internal checklist matching each diagnosis to its specific approval criteria. Flag and deny any claims for members with documented disease progression on bendamustine regimens. Train prior auth staff on five separate approval pathways based on diagnosis. Claims submitted without prior authorization will be denied by Humana Indiana Medicaid.