MedicaidPrior AuthMedium impact
Granix® (tbo-filgrastim) (Revised)
Humana·KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Granix (tbo-filgrastim) now requires prior authorization for Medicaid patients in Kentucky and South Carolina. Patients must have tried and failed Zarxio and Nivestym before Granix can be approved, along with meeting specific cancer diagnosis and neutropenia risk criteria.
Action Required
Before January 1, 2026: Billing team must implement prior authorization workflow for Granix (tbo-filgrastim) for Kentucky and South Carolina Medicaid patients. Update system to flag these prescriptions and ensure providers document previous treatment failure with Zarxio and Nivestym, non-myeloid malignancy diagnosis, and neutropenia risk factors before prescribing. Claims without prior authorization will be denied.