MedicaidPrior AuthHigh impact
Besponsa™ (inotuzumab ozogamicin)
Humana·IN · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Indiana Medicaid has implemented a new prior authorization policy for Besponsa (inotuzumab ozogamicin) effective January 1, 2026. The drug is now restricted to adult and pediatric patients (1+ years) with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL) who have documented CD22 blasts and are receiving Besponsa as monotherapy. Prior authorization is required with an initial approval duration of 6 months (maximum 6 cycles) and renewal for an additional 6 months (maximum 6 cycles).
Action Required
By January 1, 2026: Billing team must implement prior authorization workflow for all Besponsa (inotuzumab ozogamicin) claims submitted to Humana Indiana Medicaid. Before submitting claims, verify that the patient meets ALL four approval criteria: (1) B-cell precursor ALL diagnosis, (2) relapsed or refractory disease, (3) documented CD22 blasts in bone marrow or peripheral blood, and (4) Besponsa use as monotherapy only. Do NOT bill if patient meets exclusion criteria (disease progression on or after Besponsa). Update claim submission system to require prior authorization documentation before processing. Flag any claims for patients with prior Besponsa exposure or plans for hematopoietic stem cell transplant (HSCT) for clinical review due to black box warnings regarding hepatic veno-occlusive disease (VOD) and post-HSCT mortality risk. Failure to obtain prior authorization will result in claim denials. Coordinate with oncology providers at the practice to ensure they submit complete clinical documentation with each prior auth request, including liver function tests and treatment history.