Medicare AdvantagePrior AuthMedium impact
Granix® (tbo-filgrastim) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana revised their prior authorization policy for Granix (tbo-filgrastim), a medication used to prevent febrile neutropenia in cancer patients receiving chemotherapy. The policy establishes specific risk-based criteria and requires trial of preferred alternatives (Zarxio for medical benefit, Zarxio/Nivestym for Part D) before approving Granix.
Action Required
Before January 1, 2026: Billing team must update prior authorization procedures for Granix prescriptions. Ensure documentation includes: 1) Patient's febrile neutropenia risk level based on chemotherapy regimen, 2) Applicable risk factors if intermediate/low risk regimen, 3) Previous trial or intolerance to preferred products (Zarxio for medical benefit; Zarxio/Nivestym for Part D), 4) Confirmation of non-myeloid malignancy diagnosis. Update encounter forms to remind oncologists of these requirements.