Medicare AdvantagePrior AuthHigh impact
Non-Preferred Filgrastim Products: Neupogen, Nypozi, Releuko, Filkri (Revised)
Humana·Oncology, Hematology, Infectious Disease·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for non-preferred filgrastim products (Neupogen, Nypozi, Releuko, Filkri). Patients must first try preferred products Zarxio and/or Nivestym before non-preferred options will be covered, with specific step therapy requirements differing between Medical Benefit and Part D requests.
Action Required
By January 1, 2026: Update prior authorization workflows to require step therapy documentation for filgrastim products. For Medical Benefit requests, document previous treatment with or intolerance to Zarxio before requesting Neupogen, Nypozi, Releuko, or Filkri. For Medicare Part D requests, document trial of both Zarxio and Nivestym before non-preferred products. Update EMR templates to capture required clinical criteria including diagnosis codes for neutropenia conditions, chemotherapy regimens, and risk factors. Note: Medicare Part B continuation therapy within 365 days exempts step therapy requirements.