MedicaidPrior AuthMedium impact
Stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor) (Revised)
Humana·IN · Hematology, Oncology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid (Indiana) has updated prior authorization requirements for stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor) used in autologous transplants for non-Hodgkin's lymphoma and multiple myeloma. The policy specifies strict criteria including required combination with G-CSF/GM-CSF and limits treatment duration to prevent use beyond harvest completion.
Action Required
Before January 1, 2026: Billing team must update prior authorization processes for stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor) for Indiana Medicaid patients. Ensure documentation includes: NHL or multiple myeloma diagnosis, concurrent G-CSF/GM-CSF use, autologous transplant protocol confirmation, and treatment duration limits (4 days max for Mozobil/plerixafor, 2 doses max for Aphexda). Update EMR templates to capture required criteria. Claims without proper prior auth will be denied.