MedicaidPrior AuthMedium impact
Danyelza® (naxitamab-gqgk) (Revised)
Humana·OH · Oncology, Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Ohio Medicaid has established a new prior authorization policy for Danyelza (naxitamab-gqgk), a specialty cancer drug used to treat pediatric and adult patients with relapsed or refractory high-risk neuroblastoma. The policy requires specific criteria to be met including patient age 1+ years, disease location in bone/bone marrow, and mandatory combination with Leukine therapy.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for Danyelza (naxitamab-gqgk) prescriptions for Ohio Medicaid patients. Ensure providers document all five criteria: high-risk neuroblastoma diagnosis, bone/bone marrow involvement, patient age 1+ years, partial/minor response to prior therapy, and combination use with Leukine. Submit prior auth requests through www.humana.com/PAL for medical billing. Claims will be denied without proper authorization.