MedicaidPrior AuthMedium impact
Besponsa™ (inotuzumab ozogamicin)
Humana·OH · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid Ohio implemented a new prior authorization policy for Besponsa (inotuzumab ozogamicin) effective January 1, 2026. Prior authorization is now required for this CD22-directed antibody-drug conjugate used to treat relapsed or refractory B-cell precursor acute lymphoblastic leukemia. The policy establishes four approval criteria (B-cell ALL diagnosis, relapsed/refractory disease, documented CD22 blasts, monotherapy use) and one exclusion (prior disease progression on Besponsa), with initial and renewal authorizations limited to 6 months or 6 cycles.
Action Required
By December 31, 2025: Billing and clinical staff must implement prior authorization workflow for all Besponsa (inotuzumab ozogamicin) claims for Medicaid Ohio members. (1) Update billing system to flag Besponsa claims for mandatory prior authorization before submission. (2) Create or update prior authorization request templates to include required clinical documentation: B-cell precursor ALL diagnosis confirmation, evidence of relapsed or refractory disease, bone marrow or peripheral blood CD22 blast documentation, and confirmation of monotherapy use. (3) Train providers and clinical staff on the four approval criteria and one exclusion criterion (prior disease progression on Besponsa). (4) Establish authorization tracking to ensure initial approvals do not exceed 6 cycles/6 months and renewal approvals follow the same limits. (5) Reference www.humana.com/PAL for current medically billed claim codes. Failure to obtain prior authorization will result in claim denials for Ohio Medicaid members.