MedicaidPrior AuthMedium impact
Rytelo (imetelstat) (New)
Humana·OH · Hematology, Oncology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Rytelo (imetelstat), a medication used to treat myelodysplastic syndrome (MDS) related anemia. The policy requires meeting four specific clinical criteria including MDS diagnosis, disease risk level, transfusion dependence, and ESA treatment history before coverage approval.
Action Required
By December 1, 2025: Providers treating MDS patients must obtain prior authorization from Humana Medicaid Ohio before prescribing Rytelo (imetelstat). Update prior authorization checklist to include four required criteria: MDS diagnosis, low-to-intermediate-1 IPSS risk score, transfusion-dependent anemia (4+ units over 8 weeks), and ESA treatment failure/ineligibility. Visit www.humana.com/PAL for medical billing request procedures. Claims will be denied without proper prior authorization.