MedicaidPrior AuthLow impact
Prevymis™ (letermovir) (Revised)
Humana·LA · Transplant Surgery, Oncology, Nephrology +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has revised its prior authorization policy for Prevymis (letermovir), an antiviral medication used for CMV prophylaxis in transplant patients. The policy establishes specific criteria for coverage in stem cell and kidney transplant recipients, requiring prior authorization for both oral and IV formulations.
Action Required
Before January 1, 2026: Billing team must ensure prior authorization is obtained for Prevymis (letermovir) prescriptions for Louisiana Medicaid members who are transplant patients. Update system to flag these cases and verify patient meets specific age, weight, and clinical criteria outlined in the policy before submitting claims.