MedicaidPrior AuthLow impact
Sylvant® (siltuximab) (New)
Humana·OH · Oncology, Hematology, Infectious Disease·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Sylvant (siltuximab) effective January 1, 2026, for Ohio Medicaid patients with multicentric Castleman's disease. The policy requires specific diagnostic criteria and laboratory values for initial approval and continuation of therapy.
Action Required
By January 1, 2026: Billing team must update prior authorization processes for Sylvant (siltuximab) for Ohio Medicaid patients. Ensure providers document multicentric Castleman's disease diagnosis, HIV/HHV-8 negative status, and required laboratory values (neutrophil count ≥ 1.0 x 10⁹/L, platelet count ≥ 75 x 10⁹/L, hemoglobin <17 g/dL) before prescribing. Update pharmacy prior auth forms to include these criteria. Claims without proper authorization will be denied.