Medicare AdvantagePrior AuthMedium impact
Leukine® (sargramostim/GM-CSF) (Revised)
Humana·Oncology, Hematology, Transplant Surgery·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Leukine (sargramostim/GM-CSF) injections, effective January 1, 2026. The policy establishes specific criteria for coverage across multiple oncology and hematology indications including bone marrow transplants, stem cell procedures, and febrile neutropenia prophylaxis.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Leukine (sargramostim/GM-CSF) solution injections for Humana Medicare Advantage patients. Providers must document specific clinical criteria including transplant history, cancer diagnosis, chemotherapy regimen risk factors, and exclusion criteria before prescribing. Update EMR templates to capture required documentation. Claims without proper prior authorization will be denied.