Medicare AdvantagePrior AuthMedium impact
Iclusig® (ponatinib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Aug 12, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Iclusig® (ponatinib) effective January 1, 2022, with the most recent revision on April 22, 2026. The policy outlines specific approval criteria for three leukemia indications: chronic phase CML (requiring resistance/intolerance to two TKIs or T315I mutation), accelerated/blast phase CML, and Philadelphia chromosome positive acute lymphoblastic leukemia. Claims will be denied if the member has experienced disease progression while on Iclusig, and billing teams must verify all prior authorization requirements are met before claim submission to avoid denials.
Action Required
Before submitting any Iclusig claims to Humana Medicare Advantage: (1) Billing team must verify the member has a documented diagnosis of one of three covered indications: chronic phase CML, accelerated/blast phase CML, or Ph+ ALL; (2) Confirm the member meets the specific approval criteria for their diagnosis—for chronic phase CML, document either intolerance/resistance to at least two TKIs OR T315I mutation; for accelerated/blast phase, confirm no other kinase inhibitors are indicated OR T315I mutation present; for Ph+ ALL, verify no other kinase inhibitors indicated OR T315I mutation OR combination with chemotherapy; (3) Obtain prior authorization from Humana before dispensing; (4) Document in the patient record that the member has NOT experienced prior disease progression on Iclusig (exclusion criterion); (5) Ensure prescriber provides complete documentation supporting medical necessity. Failure to obtain prior authorization or meet approval criteria will result in claim denial by Humana Medicare Advantage plans.