Medicare AdvantagePrior AuthMedium impact
Ryzneuta (efbemalenograstim alfa-vuxw) (Revised)
Humana·Oncology, Hematology, Family Medicine +1 more·Medicare Advantage
Effective date
Jun 25, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing a new prior authorization policy for Ryzneuta (efbemalenograstim alfa-vuxw), a medication used to prevent febrile neutropenia in cancer patients receiving chemotherapy. The policy requires step therapy through preferred products and specific clinical criteria to be met before approval.
Action Required
Before June 25, 2025: Oncology and primary care teams must update prior authorization protocols for Ryzneuta. Ensure documentation includes non-myeloid malignancy diagnosis, chemotherapy regimen febrile neutropenia risk assessment per ASCO/NCCN guidelines, and evidence of trial/intolerance to preferred products (Neulasta, Fulphila, Udenyca for Part B; Udenyca for Part D). Update EMR templates to capture required risk factors and exclusion criteria. Failure to obtain prior auth will result in claim denials.