MedicaidPrior AuthMedium impact
Rytelo (imetelstat) (New)
Humana·IN · Hematology, Oncology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has added a new prior authorization policy for Rytelo (imetelstat), an intravenous medication for treating myelodysplastic syndrome (MDS) related anemia in Medicaid patients. The policy requires meeting four specific clinical criteria including MDS diagnosis, low-to-intermediate risk disease, transfusion dependency, and failed response to other treatments.
Action Required
Before December 1, 2025: Billing team must update prior authorization tracking for Rytelo (imetelstat) for Indiana Medicaid patients. Providers must document: MDS diagnosis, IPSS risk scoring, transfusion history (4+ blood units over 8 weeks), and ESA treatment failure/ineligibility. Visit www.humana.com/PAL for specific medical billing codes and preauthorization requirements.