Medicare AdvantagePrior AuthMedium impact
Rolvedon (eflapegrastim-xnst) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Rolvedon (eflapegrastim-xnst) injection for Medicare Advantage members requiring febrile neutropenia prophylaxis. Requires step therapy with preferred products and specific clinical criteria before approval.
Action Required
Before January 1, 2026: Update prior authorization workflow to include Rolvedon step therapy requirements. Billing team must verify patients have tried preferred products (Neulasta, Fulphila, Udenyca) before requesting Rolvedon authorization. Providers must document non-myeloid malignancy diagnosis and febrile neutropenia risk factors per ASCO/NCCN guidelines. Obtain prior auth before administering - claims will be denied without approval.