Medicare AdvantagePrior AuthMedium impact
Stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor) (Revised)
Humana·KY, SC · Hematology, Oncology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana updated prior authorization requirements for stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor) for Medicare and Medicaid patients in Kentucky and South Carolina. The policy establishes specific criteria for coverage including diagnosis requirements, combination therapy mandates, and usage limitations.
Action Required
Before January 1, 2026: Billing team must ensure prior authorization is obtained for all stem cell mobilizing agents (Mozobil, Aphexda, Plerixafor) for Humana Medicare and Medicaid patients in Kentucky and South Carolina. Verify patients meet diagnosis criteria (NHL or MM for Mozobil/plerixafor; MM only for Aphexda), confirm combination with G-CSF or GM-CSF, and document autologous stem cell transplant protocol. Claims will be denied without proper prior authorization.