MedicaidPrior AuthMedium impact
Rolvedon (eflapegrastim-xnst) (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established new prior authorization requirements for Rolvedon (eflapegrastim-xnst) for febrile neutropenia prophylaxis. Patients must have failed or have intolerance to both Fulphila and Neulasta products before Rolvedon can be approved, with specific risk factor criteria required.
Action Required
By January 1, 2026: Providers prescribing Rolvedon (eflapegrastim-xnst) for South Carolina Medicaid patients must obtain prior authorization by documenting previous treatment failure or intolerance to both Fulphila and Neulasta, confirming non-myeloid malignancy diagnosis, and meeting chemotherapy risk criteria per ASCO/NCCN guidelines. Update EMR templates to include required documentation checklist. Claims will be denied without proper prior authorization.