Medicare AdvantagePrior AuthLow impact
Niktimvo™ (axatilimab-csfr) (Revised)
Humana·KY, SC, VA · Oncology, Hematology, Transplant Surgery·Medicaid
Effective date
May 28, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Niktimvo (axatilimab-csfr), a medication used to treat chronic Graft vs Host Disease (cGVHD) after failure of at least two prior systemic therapies. Prior authorization will be required for Medicare and Medicaid plans in Kentucky, South Carolina, and Virginia, with specific criteria including diagnosis confirmation, treatment failure history, and minimum patient weight of 40kg.
Action Required
By May 28, 2025: Billing team must implement prior authorization requirements for Niktimvo (axatilimab-csfr) infusions for Humana Medicare and Medicaid members in Kentucky, South Carolina, and Virginia. Verify patient meets all three criteria: cGVHD diagnosis, failure of at least two prior systemic therapies, and weight of at least 40kg. Visit www.humana.com/PAL for specific medical billing codes. Claims will be denied without proper prior authorization.