MedicaidPrior AuthMedium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Vyxeos (daunorubicin and cytarabine liposome) effective May 1, 2026. Coverage is limited to newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), with approval for up to 6 months covering a maximum of 2 induction cycles and 2 consolidation cycles. Prior authorization is required before dispensing.
Action Required
By April 15, 2026: Billing and pharmacy teams must implement prior authorization workflow for all Vyxeos (J9312 equivalent - daunorubicin and cytarabine liposomal formulation) claims for Indiana Medicaid members. Update billing system to flag all Vyxeos prescriptions as requiring prior auth. Educate providers that Vyxeos is NOT interchangeable with conventional daunorubicin/cytarabine (7+3 regimen) and carries different dosing. Verify at point-of-service that member meets coverage criteria: (1) diagnosis of t-AML or AML-MRC documented; (2) newly diagnosed disease, post-remission therapy, or re-induction therapy. Deny authorization and contact provider if member has prior disease progression on Vyxeos or conventional daunorubicin/cytarabine regimen. Document approval duration as 6 months with renewal option. Emphasize BLACK BOX WARNING: Do not interchange Vyxeos with other daunorubicin/cytarabine formulations due to different dosing requirements. Failure to obtain prior authorization will result in claim denials.