MedicaidPrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·OH · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Jul 22, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid Ohio updated its Blincyto (blinatumomab) pharmacy coverage policy effective July 22, 2026. The policy establishes prior authorization requirements for this bispecific T-cell engager used in B-cell acute lymphoblastic leukemia (ALL) treatment across four distinct clinical scenarios: relapsed/refractory ALL, MRD-positive ALL, and consolidation phase ALL. Billing teams must ensure all Blincyto requests include documented clinical criteria and obtain prior authorization before dispensing.
Action Required
By July 22, 2026: Billing and pharmacy teams must implement prior authorization workflow for Blincyto (blinatumomab) IV kit and IV solution claims submitted to Humana Medicaid Ohio. Before claim submission, verify that the prescriber has documented one of the four covered clinical scenarios: (1) Philadelphia chromosome-negative or Ph+ relapsed/refractory B-cell ALL as monotherapy or with tyrosine kinase inhibitor; (2) B-cell precursor ALL in complete remission with MRD ≥0.1% as monotherapy or with tyrosine kinase inhibitor; (3) B-cell precursor ALL in consolidation phase of multiphase chemotherapy. Route all Blincyto requests through the prior authorization system (humana.com/PAL for medical billing codes). Obtain approval before dispensing; claims submitted without prior authorization will be denied. Update pharmacy billing system rules and encounter forms to flag Blincyto as a prior authorization-required drug. Training note: Emphasize to clinical staff that neurological toxicities occur in ~50% of patients and require close monitoring; approval may be subject to clinical review.