Medicare AdvantagePrior AuthLow impact
Besponsa™ (inotuzumab ozogamicin) (Revised)
Humana·FL, KY · Hematology, Oncology, Pharmacy·Medicaid
Effective date
Nov 26, 2025
We identified it
Aug 12, 2026
Summary
Humana revised its Besponsa (inotuzumab ozogamicin) prior authorization policy effective November 26, 2025, for Medicare and Medicaid (Florida and Kentucky). The policy maintains requirements for B-cell precursor ALL with relapsed/refractory disease and CD22+ blasts, monotherapy use only, with approval limited to 6 months (maximum 6 cycles) per authorization period. This is a routine policy revision with no substantive changes to coverage criteria.
Action Required
By December 10, 2025: Billing and prior authorization staff should verify the updated policy is loaded in your prior authorization system (reference source URL: https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5a1390). Confirm that all four approval criteria (B-cell precursor ALL diagnosis, relapsed/refractory disease, CD22+ blasts documented, monotherapy use) and the exclusion (no prior disease progression on Besponsa) are reflected in your PA request templates for Humana Medicare and Medicaid (FL/KY) plans. No claims should be affected if the prior revision was already in use. Document the revision date (11/26/2025) in your policy tracking system to ensure providers use current criteria.