MedicaidPrior AuthMedium impact
Blincyto® (blinatumomab) (Revised)
Humana·IN · Oncology, Hematology, Pediatrics·Medicaid
Effective date
Oct 1, 2025
We identified it
Aug 12, 2026
Summary
This is a revised Humana Medicaid (Indiana) prior authorization policy for Blincyto® (blinatumomab), a bispecific T-cell engager for B-cell acute lymphoblastic leukemia. The policy covers three indications: relapsed/refractory B-cell ALL (with or without Philadelphia chromosome), MRD-positive B-cell precursor ALL in first/second remission, and consolidation-phase treatment. All uses require prior authorization with approval valid for the plan year or as determined through clinical review. Notable additions include explicit mention of combination therapy with tyrosine kinase inhibitors (bosutinib, dasatinib, imatinib, nilotinib, ponatinib) and specific clinical criteria referencing blast percentages and MRD thresholds.
Action Required
By October 1, 2025: Billing team and clinical staff must implement prior authorization requirements for all Blincyto (blinatumomab) claims submitted to Humana Medicaid Indiana. (1) Update billing system and claims software to route all Blincyto intravenous kit and intravenous solution claims to require prior authorization before submission. (2) Create or update prior authorization request templates to include documentation of: diagnosis (relapsed/refractory B-cell ALL, Ph+/Ph- status, MRD positivity, or consolidation phase), treatment phase/indication, planned monotherapy or combination regimen (with specific TKI name if applicable), and relevant lab values (blast percentage, MRD level ≥0.1%, or remission status). (3) Educate providers and clinical staff on the three approval pathways and required clinical criteria, particularly the distinction between Ph+ and Ph- disease and the allowable combination therapies. (4) Establish internal tracking to monitor approval durations (plan year vs. clinical review determination) and ensure renewal requests are submitted appropriately. (5) Direct providers to reference www.humana.com/PAL for updated claim codes and preauthorization lists. Failure to obtain prior authorization before claim submission will result in claim denials for Indiana Medicaid members.