Medicare AdvantagePrior AuthMedium impact
Rytelo (imetelstat) (Revised)
Humana·FL, KY, SC · Hematology, Oncology, Internal Medicine·Medicaid
Effective date
Oct 23, 2024
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Rytelo (imetelstat), a medication used to treat myelodysplastic syndrome (MDS) related anemia. This policy requires prior authorization for Medicare, Medicaid (FL, KY, SC) members who meet specific clinical criteria including low- to intermediate-1 risk MDS with transfusion-dependent anemia.
Action Required
Immediately: Billing team must obtain prior authorization for all Rytelo (imetelstat) prescriptions for Humana Medicare and Medicaid members in Florida, Kentucky, and South Carolina. Verify patients meet all four clinical criteria before requesting authorization. Visit www.humana.com/PAL for specific medical and procedural coding requirements. Claims will be denied without proper prior authorization.