MedicaidPrior AuthHigh impact
Gazyva® (obinutuzumab)
Humana·IN · Hematology, Oncology, Nephrology·Medicaid
Effective date
Feb 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Indiana Medicaid has issued 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 approval criteria for each indication, including required combination therapies, exclusions for disease progression, and maintenance therapy limits. Billing teams must implement prior authorization requirements before administering this drug to Indiana Medicaid members.
Action Required
By January 31, 2026: Billing team must implement prior authorization requirement in billing system for HCPCS code J9301 (Gazyva injection) for all Indiana Medicaid claims. Update claim submission workflow to: (1) Route all Gazyva requests through prior auth process before dispensing; (2) Verify member diagnosis matches one of three covered indications (CLL, follicular lymphoma, or lupus nephritis); (3) Confirm appropriate combination therapy or monotherapy per policy criteria; (4) Check for exclusion criteria (disease progression on Gazyva, or maintenance therapy >2 years for follicular lymphoma). Provider staff must obtain prior authorization documentation before billing. Clinical staff should review boxed warnings (HBV reactivation, PML risk) during medical necessity review. Update provider communications and encounter forms to alert clinicians that Gazyva requires prior auth for Indiana Medicaid. Claims submitted without approved prior authorization will be denied.