MedicaidPrior AuthMedium impact
Ryzneuta (efbemalenograstim alfa-vuxw) (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Ryzneuta (efbemalenograstim alfa-vuxw), a long-acting growth factor for febrile neutropenia prophylaxis in cancer patients. Requires prior treatment with or intolerance to Neulasta, diagnosis of non-myeloid malignancy, and specific risk criteria based on chemotherapy regimen and patient factors.
Action Required
By January 1, 2026: Billing team must update prior authorization system to require approval for Ryzneuta prescriptions for Kentucky Medicaid patients. Providers must document previous Neulasta treatment/intolerance, non-myeloid malignancy diagnosis, and chemotherapy regimen risk factors per ASCO/NCCN guidelines. Claims will be denied without proper prior authorization.