Medicare AdvantagePrior AuthMedium impact
Inrebic® (fedratinib) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicare Advantage updated its prior authorization policy for Inrebic® (fedratinib) effective January 1, 2026, with a revision dated May 27, 2026. The policy requires prior authorization for this JAK2/FLT3 inhibitor used to treat intermediate-2 or high-risk myelofibrosis, with mandatory criteria including diagnosis confirmation, risk stratification, monotherapy use, and documented medical reason for not using Jakafi (ruxolitinib). Critical change: All patients must have thiamine levels assessed before treatment initiation due to a black box warning for Wernicke's encephalopathy.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization workflow for Inrebic (fedratinib) claims for Medicare Advantage members with myelofibrosis. Update billing system to flag all Inrebic requests for prior auth review. Ensure clinical staff verify all four approval criteria before claim submission: (1) primary or secondary myelofibrosis diagnosis, (2) Intermediate-2 or High-risk disease per IPSS/DIPSS/DIPSS-PLUS, (3) monotherapy use, and (4) documented medical reason why Jakafi cannot be used. Providers must include thiamine level assessment documentation with all initial requests per black box warning. Deny or request additional information for any claims showing prior disease progression on Inrebic (Exclusion #1). Train billing and prior auth staff on the four mandatory approval criteria and the thiamine deficiency exclusion. Update claim denial templates to reference specific unmet criteria. Verify member's Medicare Advantage plan enrollment before processing—this policy applies only to Humana Medicare Advantage plans, not Traditional Medicare. Failure to obtain proper prior authorization will result in claim denials.