Medicare AdvantagePrior AuthMedium impact
Besremi (ropeginterferon alfa-2b-njft) (Revised)
Humana·Hematology, Oncology, Pharmacy·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Aug 12, 2026
Summary
Humana has revised its Besremi (ropeginterferon alfa-2b-njft) prior authorization policy effective November 26, 2025. This is a pharmacy coverage policy for polycythemia vera treatment that requires prior authorization before dispensing. The policy includes one inclusion criterion (PV diagnosis) and six exclusion criteria (hepatic decompensation, severe psychiatric disorders, immunosuppressed transplant recipients, hypersensitivity, active autoimmune disease, and disease progression on Besremi). Approval is granted for the plan year duration with renewal based on clinical review.
Action Required
By November 26, 2025: Billing and clinical team must implement prior authorization requirement for Besremi (ropeginterferon alfa-2b-njft) subcutaneous syringe and pen injector for all Medicare Advantage members. Update billing system to route all Besremi claims through prior authorization workflow before claim submission. Clinical review team must verify: (1) member has polycythemia vera diagnosis, and (2) member does NOT meet any of six exclusion criteria (hepatic decompensation with Child-Pugh >6, severe psychiatric disorders/suicidal ideation, immunosuppressed transplant recipient status, hypersensitivity to interferon, active autoimmune disease, or prior disease progression on Besremi). Ensure pharmacy staff and providers understand two-week monitoring requirement during titration and dose modification phases. Do not approve if any exclusion criteria are met. Claims submitted without prior authorization will be denied.