MedicaidPrior AuthLow impact
Defitelio® (defibrotide sodium) (New)
Humana·LA · Hematology, Oncology, Transplant Surgery·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has introduced a new prior authorization policy for Defitelio (defibrotide sodium) for Louisiana Medicaid patients effective June 1, 2026. This medication treats veno-occlusive disease following stem cell transplants and requires documentation of specific criteria including HSCT diagnosis and renal/pulmonary dysfunction.
Action Required
By June 1, 2026: Billing and clinical teams must implement prior authorization requirements for Defitelio (defibrotide sodium) for Louisiana Medicaid patients. Update billing system to flag this medication for prior auth. Providers must document: 1) VOD/SOS diagnosis following hematopoietic stem-cell transplantation, 2) renal or pulmonary dysfunction, and 3) absence of concomitant anticoagulant/fibrinolytic therapy. Visit www.humana.com/PAL for specific procedure codes. Claims will be denied without prior authorization.