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HumanaMedicaid · Prior Auth · Medicaid · LA · Oncology, Rheumatology, HematologyHigh impact

Gazyva® (obinutuzumab)

Act
by Jan 31, 2026
Effective date
Feb 1, 2026
Identified
Aug 12, 2026

Summary

Humana Louisiana Medicaid has implemented a new prior authorization policy for Gazyva (obinutuzumab) effective February 1, 2026, covering three indications: chronic lymphocytic leukemia, follicular lymphoma, and lupus nephritis. The policy establishes specific clinical criteria for approval, including required combination therapies, disease status requirements, and maintenance therapy limits. Billing teams must implement prior authorization requirements before claims submission to avoid denials.

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What to do

by Jan 31, 2026 · 7 steps
01Billing team must update billing software to require prior authorization for all Gazyva (obinutuzumab) claims submitted to Humana Louisiana Medicaid.
02Implement authorization checkpoints in the billing system requiring verification of: (1) member diagnosis (CLL, follicular lymphoma, or lupus nephritis), (2) required combination therapy or approved monotherapy status, (3) absence of prior disease progression on Gazyva, and (4) for follicular lymphoma, confirmation that maintenance therapy does not exceed 2 years.
03Update claim submission templates to flag HCPCS J9301 with diagnosis codes C91.1 (CLL), C82.x (follicular lymphoma), or N08.3 (lupus nephritis).
04Providers must document medication regimen details (combination agent names or monotherapy status) and clinical response status.
05Contact Humana for specific prior authorization submission requirements at www.humana.com/PAL.
06Claims submitted without prior authorization will be denied.
07Communicate policy requirements to all oncology and rheumatology providers in network.

Codes mentioned

J9301

Original notice

Gazyva® (obinutuzumab)
mcp.humana.com · Always check the source before changing claims.
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Related policy hubs

Humana policiesLA policy changesOncologyRheumatologyHematologyCode J9301

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