Medicare AdvantagePrior AuthMedium impact
Intravenous Iron Products (Revised)
Humana·KY, SC, VA · Internal Medicine, Nephrology, Cardiology +4 more·Medicaid
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its Intravenous Iron Products prior authorization policy (effective March 25, 2026) for Medicaid in Kentucky, South Carolina, and Virginia, and Medicare plans. The policy requires prior authorization for four IV iron products (Feraheme, Injectafer, Monoferric, ferumoxytol) with mandatory step therapy: patients must have documented prior therapy failure, contraindication, or intolerance to Infed (iron dextran) and Venofer (iron sucrose) before approval, except Medicare Part B continuation requests within 365 days. This is a billing workflow change requiring enhanced documentation review before claims submission.
Action Required
By March 25, 2026: Billing team must implement prior authorization requirement for all IV iron product claims (Feraheme/ferumoxytol, Injectafer, Monoferric) for Medicaid-Kentucky, Medicaid-South Carolina, Medicaid-Virginia, and Medicare plans. Before claim submission: (1) Verify patient has documented diagnosis of iron deficiency anemia; (2) Confirm prior therapy, contraindication, or intolerance to both Infed and Venofer is documented in medical record—this is mandatory for all requests EXCEPT Medicare Part B continuation therapy within past 365 days; (3) Route all new requests through prior authorization system at www.humana.com/PAL; (4) For Medicare Part B renewals within 365 days of prior approval, documentation of step therapy requirements may be waived. Update billing software to flag IV iron product claims for prior auth verification. Front desk staff should screen patient charts during scheduling to identify missing prior therapy documentation. Claims submitted without documented step therapy evidence (except valid Medicare continuations) will be denied. Providers must include prior therapy details in PA request.