MedicaidPrior AuthMedium impact
Kyprolis® (carfilzomib) (Revised)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Kyprolis (carfilzomib) for Ohio Medicaid patients. The policy now includes specific criteria for multiple myeloma and Waldenstrom's macroglobulinemia treatment combinations, with detailed exclusions for patients who have experienced disease progression while on Kyprolis.
Action Required
By December 1, 2025: Billing team must update prior authorization processes for Kyprolis (carfilzomib) submissions to Ohio Medicaid. Verify patients meet specific diagnosis criteria (multiple myeloma or Waldenstrom's macroglobulinemia) and combination therapy requirements before treatment initiation. Document that patients have not experienced disease progression while on Kyprolis previously, as this will result in denial.