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HumanaMedicaid · Prior Auth · Medicaid · OH · Oncology, Hematology, PediatricsMedium impact

Blincyto (blinatumomab) (Revised)

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Sep 26, 2026

Summary

Humana Medicaid (Ohio) updated its prior authorization policy for Blincyto (blinatumomab) effective October 1, 2025, with a revision dated July 22, 2026. The policy covers three treatment indications for B-cell acute lymphoblastic leukemia: relapsed/refractory disease (with or without Philadelphia chromosome), MRD-positive disease in complete remission, and consolidation phase therapy. Prior authorization is required for all uses, with approval duration determined by plan year or clinical review.

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What to do

by Oct 1, 2025 · 5 steps
01Billing and prior authorization teams must update systems to require prior authorization for Blincyto (blinatumomab) claims under Humana Medicaid Ohio.
02Verify that all three treatment scenarios are recognized in the PA workflow: (1) relapsed/refractory B-cell ALL (Ph- as monotherapy; Ph+ as monotherapy or with tyrosine kinase inhibitors), (2) MRD-positive B-cell precursor ALL in first or second complete remission (as monotherapy or with TKI), and (3) consolidation phase therapy.
03Configure approval duration to align with plan year or clinical review determination.
04Educate oncology providers and support staff on new criteria to ensure claims include documentation of diagnosis, disease status, prior treatments, and intended use (monotherapy vs. combination).
05Flag claims lacking this documentation for denial prevention.

Codes mentioned

J9033

Original notice

Blincyto (blinatumomab) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related policy hubs

Humana policiesOH policy changesOncologyHematologyPediatricsCode J9033

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