MedicaidPrior AuthMedium impact
Non-Preferred Pegfilgrastim Products (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina updated prior authorization requirements for non-preferred pegfilgrastim products (Fylnetra, Nyvepria, Stimufend, Udenyca, Ziextenzo). These products now require prior authorization with specific criteria including previous treatment failure with preferred products and risk-based neutropenia prophylaxis requirements.
Action Required
By January 1, 2026: Billing team must update prior authorization requirements for non-preferred pegfilgrastim products (Fylnetra, Nyvepria, Stimufend, Udenyca, Ziextenzo) for Humana Medicaid South Carolina patients. Ensure documentation shows previous treatment failure with both Fulphila and Neulasta products, non-myeloid malignancy diagnosis, and appropriate neutropenia risk assessment per ASCO/NCCN guidelines. Update encounter forms to capture required risk factors and exclusion criteria.