MedicaidPrior AuthMedium impact
Preferred Filgrastim Products (Revised)
Humana·KY, SC · Oncology, Hematology, Infectious Disease·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated its prior authorization policy for preferred filgrastim products (Nivestym and Zarxio) effective January 1, 2026, for Kentucky and South Carolina Medicaid plans. The policy establishes specific criteria for coverage across 11 different indications including febrile neutropenia treatment and prophylaxis, with all approvals requiring prior authorization and lasting 6 months initially.
Action Required
Immediately: Billing team must ensure prior authorization is obtained before prescribing Nivestym or Zarxio for Kentucky and South Carolina Medicaid patients. Update billing system to flag these medications as requiring prior auth. Providers must verify patients meet specific diagnostic and clinical criteria outlined in the policy before requesting authorization. Claims will be denied without proper prior authorization.