MedicaidPrior AuthHigh impact
Gazyva® (obinutuzumab)
Humana·LA · Oncology, Rheumatology, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
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.
Action Required
By January 31, 2026: Billing team must update billing software to require prior authorization for all Gazyva (obinutuzumab) claims submitted to Humana Louisiana Medicaid. Implement 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. Update claim submission templates to flag HCPCS J9301 with diagnosis codes C91.1 (CLL), C82.x (follicular lymphoma), or N08.3 (lupus nephritis). Providers must document medication regimen details (combination agent names or monotherapy status) and clinical response status. Contact Humana for specific prior authorization submission requirements at www.humana.com/PAL. Claims submitted without prior authorization will be denied. Communicate policy requirements to all oncology and rheumatology providers in network.