MedicaidPrior AuthMedium impact
Non-Preferred Pegfilgrastim Products (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Kentucky has updated prior authorization requirements for non-preferred pegfilgrastim products (biosimilars like Fulphila, Udenyca, Nyvepria) effective January 1, 2026. Members must have previous treatment with or intolerance to Neulasta before these biosimilars can be approved, along with meeting specific cancer diagnosis and risk factor criteria.
Action Required
Immediately: Billing team must update prior authorization protocols for pegfilgrastim biosimilar products (Fulphila, Fylnetra, Nyvepria, Stimufend, Udenyca, Ziextenzo) for Kentucky Medicaid patients. Ensure providers document previous Neulasta treatment/intolerance, non-myeloid malignancy diagnosis, and chemotherapy regimen risk factors before prescribing. Claims will be denied without proper prior authorization meeting all criteria.