MedicaidPrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·LA · Hematology, Oncology, Pediatrics·Medicaid
Effective date
Oct 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Louisiana Medicaid updated its Blincyto (blinatumomab) prior authorization policy effective October 1, 2025, with a revision date of July 22, 2026. The policy establishes coverage criteria for three B-cell acute lymphoblastic leukemia (ALL) indications: relapsed/refractory ALL, MRD-positive ALL in complete remission, and consolidation-phase ALL. All uses require prior authorization with approval duration tied to plan year or clinical review. This is a comprehensive pharmacy policy with BLACK BOX WARNINGS regarding cytokine release syndrome and neurological toxicities that clinicians must monitor.
Action Required
By October 1, 2025: Billing and clinical teams must implement prior authorization requirements for all Blincyto (blinatumomab) claims submitted to Louisiana Medicaid members under Humana. Specific actions: (1) Update billing system to flag all Blincyto claims for mandatory prior authorization before claim submission; (2) Ensure authorization requests include member diagnosis (Philadelphia chromosome status if relapsed/refractory, remission status if MRD-positive, or consolidation phase status); (3) For relapsed/refractory cases, document whether treatment is monotherapy or combination with tyrosine kinase inhibitors (bosutinib, dasatinib, imatinib, nilotinib, ponatinib); (4) For MRD-positive cases, confirm first or second complete remission and MRD level ≥0.1%; (5) Provide prior auth approval documentation to infusion centers or pharmacies before drug dispensing. Failure to obtain prior authorization will result in claim denials. Oncology and hematology providers must be notified of BLACK BOX WARNINGS (cytokine release syndrome and neurological toxicities) and monitoring requirements.