Medicare AdvantagePrior AuthHigh impact
Preferred Filgrastim Products (MA/MAPD): Zarxio, Nivestym (Revised)
Humana·Oncology, Hematology, Infectious Disease +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their prior authorization policy for filgrastim products (Zarxio and Nivestym), establishing specific preferred products based on benefit type and detailed clinical criteria for various neutropenia-related conditions. The policy requires prior authorization for all covered indications with 6-month approval durations.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Zarxio and Nivestym injections for Humana Medicare Advantage patients. Update billing system to flag these medications for prior auth. Providers must document specific clinical criteria including diagnosis, risk factors, and timing restrictions. Create workflow to verify preferred products: Zarxio for Medical Benefit requests, both Zarxio and Nivestym for Part D requests. Claims will be denied without proper prior authorization.