MedicaidPrior AuthMedium impact
Prevymis™ (letermovir) (Revised)
Humana·IN · Transplant Surgery, Oncology, Infectious Disease +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established prior authorization requirements for Prevymis (letermovir) for CMV prophylaxis in stem cell and kidney transplant patients. The policy requires specific clinical criteria including transplant type, CMV serology status, age/weight requirements, and timing of initiation.
Action Required
Before January 1, 2026: Billing team must implement prior authorization process for Prevymis (letermovir) prescriptions for Humana Medicaid Indiana members. Providers must document patient meets specific criteria including transplant type, CMV serology status, age/weight requirements, and initiation timing. Create workflow to verify prior auth approval before dispensing medication to avoid claim denials.