MedicaidPrior AuthMedium impact
Rolvedon (eflapegrastim-xnst) (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Rolvedon (eflapegrastim-xnst), a long-acting injection for preventing febrile neutropenia in cancer patients. Requires prior treatment failure with Neulasta and specific risk criteria based on chemotherapy regimen and patient factors.
Action Required
Before January 1, 2026: Billing team and oncology providers must establish prior authorization workflow for Rolvedon (eflapegrastim-xnst) prescriptions. Verify patients have tried Neulasta first, confirm non-myeloid malignancy diagnosis, and document chemotherapy regimen's febrile neutropenia risk per ASCO/NCCN guidelines. Update pharmacy prior auth forms to include required risk factors. Claims will be denied without proper authorization.