MedicaidPrior AuthMedium impact
Levoleucovorin products (Revised)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has updated prior authorization requirements for levoleucovorin products (Fusilev, Khapzory) used in cancer treatment and methotrexate toxicity management. The policy requires patients to have failed or experienced side effects with standard leucovorin calcium therapy before approving these specialized products.
Action Required
Immediately: For Indiana Medicaid patients needing levoleucovorin products, billing team must obtain prior authorization by documenting that patient was previously treated with leucovorin calcium and either experienced documented side effects due to lack of efficacy or formulation issues necessitating therapy change. Ensure all claims include appropriate diagnosis codes for osteosarcoma, methotrexate toxicity, or advanced metastatic colorectal cancer. Claims will be denied without proper prior authorization documentation.