MedicaidPrior AuthMedium impact
Rytelo (imetelstat) (New)
Humana·LA · Hematology, Oncology, Internal Medicine·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Rytelo (imetelstat), a new IV medication for treating myelodysplastic syndrome (MDS) related anemia. This drug requires prior auth and must meet four specific clinical criteria including MDS diagnosis, low-to-intermediate risk disease, transfusion-dependent anemia, and failure of erythropoiesis-stimulating agents.
Action Required
Before December 1, 2025: Billing and clinical teams must update prior authorization procedures for Rytelo (imetelstat). Ensure providers document all four required criteria: MDS diagnosis, IPSS risk scoring, transfusion dependence (4+ units over 8 weeks), and ESA treatment failure/ineligibility. Visit www.humana.com/PAL to obtain specific medical billing codes. Claims will require prior authorization approval before treatment.