MedicaidPrior AuthLow impact
Danyelza® (naxitamab-gqgk) (Revised)
Humana·IN · Oncology, Pediatrics·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established new prior authorization requirements for Danyelza (naxitamab-gqgk), a specialized cancer drug for treating relapsed or refractory neuroblastoma in pediatric and adult patients. The policy requires specific criteria to be met including age requirements, disease location, and combination therapy protocols.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization procedures for Danyelza (naxitamab-gqgk) for Indiana Medicaid patients. Ensure documentation includes diagnosis of relapsed/refractory high-risk neuroblastoma, disease location in bone/bone marrow, patient age 1+ years, response to prior therapy, and confirmation of combination use with Leukine (sargramostim). Submit prior auth requests through www.humana.com/PAL for medical billing. Claims will be denied without proper authorization.