Medicare AdvantagePrior AuthMedium impact
Fosaprepitant products (Emend, Focinvez) (New)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for fosaprepitant products (Emend, Focinvez) used to prevent chemotherapy-induced nausea and vomiting. Coverage requires specific criteria including use with highly or moderately emetogenic chemotherapy and combination with corticosteroids and 5-HT3 antagonists.
Action Required
Before January 1, 2026: Billing team must update prior authorization procedures for fosaprepitant products (Emend, Focinvez) for Humana Medicare Advantage patients. Verify patients meet all three criteria: prophylaxis use only, receiving HEC or MEC chemotherapy, and using combination antiemetic regimen with corticosteroids and 5-HT3 antagonists. Visit www.humana.com/PAL for specific medical coding requirements. Claims will be denied without proper prior authorization.