Medicare AdvantagePrior AuthHigh impact
Non-preferred Pegfilgrastim Products: Fylnetra, Nyvepria, Stimufend, Ziextenzo (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their prior authorization policy for non-preferred pegfilgrastim biosimilars (Fylnetra, Nyvepria, Stimufend, Ziextenzo), requiring step therapy through preferred products first. The policy covers febrile neutropenia prophylaxis, radiation syndrome treatment, and stem cell mobilization with specific clinical criteria and risk factor requirements.
Action Required
Before January 1, 2026: Clinical and billing teams must implement prior authorization workflows for Fylnetra, Nyvepria, Stimufend, and Ziextenzo. Ensure patients try preferred products (Neulasta, Fulphila, Udenyca) first unless contraindicated. Update EMR templates to document required clinical criteria including cancer diagnosis, chemotherapy regimen risk assessment, and risk factors. Train staff on 6-month approval durations and renewal requirements.