Medicare AdvantagePrior AuthHigh impact
Brukinsa™ (zanubrutinib) (Revised)
Humana·Oncology, Hematology, Pharmacy·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicare Advantage has updated its Brukinsa (zanubrutinib) prior authorization policy effective April 22, 2026. The policy now covers five hematologic malignancies with specific criteria: mantle cell lymphoma (requires prior therapy and monotherapy use), CLL/SLL (diagnosis-based), marginal zone lymphoma (requires second-line use, prior anti-CD20 therapy, and monotherapy), Waldenström's macroglobulinemia (monotherapy only), and follicular lymphoma (requires 2+ prior lines and combination with obinutuzumab). All indications exclude patients with disease progression on or after Brukinsa. Billing teams must ensure prior authorization is obtained before claims submission for any of these conditions.
Action Required
By April 22, 2026: Billing and prior authorization teams must implement the following requirements for Humana Medicare Advantage plans: (1) All Brukinsa prescriptions for any of the five covered indications require prior authorization before claim submission; (2) For mantle cell lymphoma claims, verify patient has received at least one prior therapy and confirm monotherapy use in the authorization request; (3) For CLL/SLL claims, verify diagnosis only—no additional therapy requirements; (4) For marginal zone lymphoma claims, confirm second-line/subsequent treatment status, prior anti-CD20 regimen receipt, and monotherapy use; (5) For Waldenström's macroglobulinemia claims, verify monotherapy use; (6) For follicular lymphoma claims, confirm relapsed/refractory status, 2+ prior lines of systemic therapy, and combination use with obinutuzumab; (7) For ALL indications, deny or request modification if patient has experienced disease progression while on or after Brukinsa treatment. Update prior authorization templates, billing software, and provider communication materials to reflect these requirements. Train billing staff on the five distinct approval pathways. Failure to obtain proper prior authorization will result in claim denials. Reference Humana's PAL (Preauthorization and Notification List) website for applicable medical/procedural coding.