Medicare AdvantagePrior AuthMedium impact
Hypomethylating agents (azacitidine, decitabine) (Revised)
Humana·Hematology, Oncology·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Aug 12, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for hypomethylating agents (azacitidine/Vidaza and decitabine/Dacogen) effective January 1, 2023, with the most recent revision dated June 24, 2026. The policy maintains prior authorization requirements for three indications: Myelodysplastic Syndromes (MDS), Acute Myelogenous Leukemia (AML), and Myeloproliferative Neoplasms (myelofibrosis). Approval duration is for the initial plan year or as determined through clinical review.
Action Required
Before submitting claims for azacitidine (Vidaza) or decitabine (Dacogen): (1) Billing team must verify member has one of the three covered diagnoses (MDS, AML, or myelofibrosis accelerated/blast phase). (2) Obtain prior authorization through Humana before dispensing these pharmacy medications—do not rely on printed copies of this policy. (3) For MDS cases, confirm member age is 18 or older and there is no hypersensitivity to azacitidine or mannitol documented. (4) Reference www.humana.com/PAL for updated medical claim coding if applicable. (5) Appeals or clinical reviews should be directed to Humana's medical director. Failure to obtain prior authorization will result in claim denials. Update all workflow systems and provider reminders to require prior auth verification before any azacitidine or decitabine claims are submitted to Humana Medicare Advantage plans.