MedicaidPrior AuthLow impact
Prevymis™ (letermovir) (New)
Humana·OH · Transplant Surgery, Oncology, Nephrology +1 more·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Prevymis (letermovir), an antiviral medication used for CMV prophylaxis in stem cell and kidney transplant recipients. This policy establishes specific coverage criteria and approval durations for both oral and IV formulations.
Action Required
By June 1, 2026: Billing team must update prior authorization workflows for Prevymis (letermovir) prescriptions for Humana Medicaid Ohio members. Ensure providers understand the specific criteria for HSCT patients (CMV-seropositive recipients, at least 6 months old, 6+ kg, initiated within 28 days post-transplant) and kidney transplant patients (high-risk D+/R-, at least 12 years old, 40+ kg, medical reason valganciclovir cannot be used). Claims without proper prior authorization will be denied.