Medicare AdvantagePrior AuthMedium impact
Bosulif® (bosutinib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Aug 12, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Bosulif (bosutinib) effective January 1, 2022, with the most recent revision dated April 22, 2026. The policy defines coverage criteria for CML treatment, requiring prior authorization and establishing specific approval/denial criteria based on disease phase, treatment history, and genetic mutations. Billing teams must verify all Bosulif claims meet the documented clinical criteria before submission to avoid denials.
Action Required
By April 22, 2026: Billing and prior authorization teams must implement the revised Bosulif coverage criteria in billing systems and PA workflows. Specifically: (1) Verify all new Bosulif authorization requests document Philadelphia chromosome positive CML diagnosis; (2) Confirm claims meet at least one of the following: accelerated/blast phase CML, OR newly-diagnosed chronic phase CML with intermediate/high-risk disease progression, OR chronic phase CML with imatinib contraindication/intolerance, OR previously-treated chronic phase CML; (3) Screen all requests for exclusion criteria—deny coverage if patient has disease progression on Bosulif or carries T315I, V299L, G250E, or F317L mutations; (4) Update prior authorization templates and decision trees to reflect these requirements; (5) Brief providers on new mutation screening requirements before claim submission. Failure to apply these criteria will result in claim denials for non-compliant requests.