Medicare AdvantagePrior AuthMedium impact
Sustol® granisetron (New)
Humana·KY, SC · Oncology·Medicaid
Effective date
Jul 23, 2025
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Sustol® (granisetron extended-release injection) used to prevent chemotherapy-induced nausea and vomiting. The policy requires prior authorization for Medicare and Medicaid patients in Kentucky and South Carolina, with specific criteria including failure of IV ondansetron/granisetron or use for highly/moderately emetogenic chemotherapy.
Action Required
By July 23, 2025: Billing team must update prior authorization workflow for Sustol® (granisetron extended-release injection) for Humana Medicare and Medicaid patients in Kentucky and South Carolina. Ensure documentation shows either failure of IV ondansetron/granisetron or use for highly/moderately emetogenic chemotherapy. Provider must obtain prior auth before administration or claims will be denied.