MedicaidPrior AuthMedium impact
Preferred Pegfilgrastim Products: Neulasta/Neulasta Onpro (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Kentucky Medicaid has updated prior authorization requirements for Neulasta/Neulasta Onpro (pegfilgrastim) effective January 1, 2026. The policy establishes specific criteria for febrile neutropenia prophylaxis, acute radiation syndrome, and stem cell mobilization, with 6-month approval durations.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Neulasta/Neulasta Onpro requests for Kentucky Medicaid patients. Verify patients meet specific criteria including non-myeloid malignancy diagnosis and chemotherapy risk factors before submitting requests. Update billing system to flag these products for prior auth requirements. Claims will be denied without proper authorization.