MedicaidPrior AuthMedium impact
Besponsa™ (inotuzumab ozogamicin)
Humana·LA · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Louisiana Medicaid has implemented a new prior authorization policy for Besponsa (inotuzumab ozogamicin) effective January 1, 2026. The policy requires prior authorization for this CD22-directed antibody-drug conjugate used to treat relapsed or refractory B-cell precursor acute lymphoblastic leukemia in patients 1 year and older. Coverage is limited to monotherapy with approval for up to 6 cycles per authorization period, and claims will be denied if members have experienced disease progression while on or following Besponsa treatment.
Action Required
By December 31, 2025: Billing and clinical teams must implement prior authorization requirements for Besponsa (inotuzumab ozogamicin, HCPCS J9313) for Louisiana Medicaid members. Update billing system to automatically route Besponsa claims for prior authorization review. Providers must document: (1) B-cell precursor ALL diagnosis, (2) relapsed or refractory disease status, (3) CD22 blasts in bone marrow or peripheral blood, and (4) monotherapy use. Verify member has no history of disease progression on prior Besponsa treatment before submitting authorization requests. Set authorization duration limits in system for initial and renewal periods (maximum 6 cycles per 6-month period). Front desk and clinical staff should add Besponsa to preauthorization checklists for Louisiana Medicaid oncology patients. Failure to obtain prior authorization will result in claim denials.