MedicaidPrior AuthMedium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (New)
Humana·LA · Oncology, Pharmacy·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Louisiana has established a NEW prior authorization policy (effective May 1, 2026) for Vyxeos (daunorubicin and cytarabine) liposome injection. Coverage is limited to adults with newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), and approvals are capped at 2 cycles of induction plus 2 cycles of consolidation per 6-month authorization period. Claims will be denied if the member has experienced prior disease progression on Vyxeos or conventional daunorubicin/cytarabine regimens.
Action Required
By May 1, 2026: Billing team must implement prior authorization requirement for Vyxeos (HCPCS J9119) in the billing system for all Louisiana Medicaid claims. Update claim submission workflows to: (1) require prior auth submission before billing, (2) verify member meets criteria (t-AML or AML-MRC diagnosis, newly diagnosed or post-remission/re-induction status), (3) confirm no prior disease progression on Vyxeos or conventional daunorubicin/cytarabine, and (4) limit authorizations to maximum 2 induction + 2 consolidation cycles per 6-month period. Provider orders and encounter forms should be updated to include diagnosis verification checklist. Oncology providers must submit clinical documentation supporting medical necessity with each prior auth request. Claims submitted without prior authorization or exceeding cycle limits will be denied. Communicate policy to all oncology providers in Louisiana panel.