MedicaidPrior AuthMedium impact
Ryzneuta (efbemalenograstim alfa-vuxw) (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established prior authorization requirements for Ryzneuta (efbemalenograstim alfa-vuxw), a new leukocyte growth factor for febrile neutropenia prophylaxis in cancer patients. Prior auth requires previous treatment failure with or intolerance to both Fulphila and Neulasta products, plus specific cancer diagnosis and risk criteria.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Ryzneuta (efbemalenograstim alfa-vuxw) for South Carolina Medicaid patients. Update billing system to flag this medication and create provider checklist requiring documentation of: 1) Previous treatment failure/intolerance to both Fulphila and Neulasta, 2) Non-myeloid malignancy diagnosis, 3) Chemotherapy regimen risk assessment per ASCO/NCCN guidelines. Approval duration is 6 months initial/renewal. Claims will be denied without prior authorization.