Medicare AdvantagePrior AuthHigh impact
Preferred Filgrastim Products (PDP): Nivestym (Revised)
Humana·Oncology, Hematology, Infectious Disease·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage (PDP) has established new prior authorization requirements for Nivestym (filgrastim-aafi) injections and subcutaneous syringes across 11 specific clinical indications including febrile neutropenia treatment/prophylaxis, stem cell harvesting, and various neutropenic conditions. All approvals are limited to 6-month initial and renewal periods with specific clinical criteria that must be met.
Action Required
Before January 1, 2026: Billing team must implement prior authorization requirements for all Nivestym (filgrastim-aafi) subcutaneous syringes and injection solutions for Humana Medicare PDP patients. Update billing system to flag these products and establish workflow to verify patient meets specific clinical criteria for one of 11 covered indications before administration. Ensure providers document appropriate diagnosis codes and risk factors. Claims will require prior approval for 6-month periods.