Medicare AdvantagePrior AuthHigh impact
Preferred Pegfilgrastim Products: Neulasta/Neulasta Onpro, Udenyca/Udenyca Onbody, Fulphila (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for pegfilgrastim products (Neulasta, Udenyca, Fulphila) effective January 1, 2026. The policy establishes preferred products and specific criteria for febrile neutropenia prophylaxis, radiation syndrome treatment, and stem cell mobilization.
Action Required
By January 1, 2026: Billing team must obtain prior authorization for all pegfilgrastim products (Neulasta, Udenyca, Fulphila) for Medicare Advantage patients. Verify patient meets diagnosis criteria for non-myeloid malignancy and chemotherapy regimen risk factors. Providers must document chemotherapy regimen FN risk percentage and any applicable risk factors. Claims will be denied without proper prior authorization.