Medicare AdvantagePrior AuthHigh impact
Imatinib products (Gleevec, Imkeldi) (Revised)
Humana·Oncology, Hematology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Aug 12, 2026
Summary
Humana Medicare Advantage updated its prior authorization policy for imatinib products (Gleevec, Imkeldi) effective January 1, 2025, with a revision dated January 28, 2026. The policy clarifies coverage criteria for nine indications including CML, ALL, GIST, melanoma, and others, requiring prior authorization for all uses. A critical exclusion applies across all indications: members who have experienced disease progression while on imatinib are not eligible for coverage.
Action Required
By January 1, 2025 (retrospectively now—immediately for all ongoing cases): Billing team must ensure ALL imatinib prescriptions (Gleevec, Imkeldi, and generic imatinib tablets and oral solutions) require prior authorization before claim submission. Update billing system and claims submission workflows to flag imatinib requests for PA review. Verify that prior authorization requests include: (1) specific diagnosis from the covered indications list; (2) for brand products, documented intolerance or contraindication to generic imatinib; (3) confirmation that member has NOT experienced disease progression on prior imatinib therapy. For pediatric CML and ALL cases, verify member age documentation (minimum 1 year old). For brand Gleevec or Imkeldi requests, obtain physician attestation of intolerance/contraindication before submission. Deny or request additional documentation for any claims where members have prior imatinib disease progression noted in records. Train providers and prior auth staff on the expanded indication-specific criteria. Consult current Humana policy portal to confirm this is still the active version before processing any imatinib authorization.