Summary
Humana revised its Nplate (romiplostim) prior authorization policy for Medicare Advantage members, effective January 1, 2021, with the most recent revision dated April 22, 2026. The policy maintains prior authorization requirements for two indications: chronic ITP (requiring platelet count <50 x10⁹/L and documented corticosteroid failure/intolerance) and Hematopoietic Syndrome of Acute Radiation Syndrome (HS-ARS). Initial and renewal approvals are limited to 3-month durations. Billing teams must ensure all requests include required clinical documentation and platelet count verification before submission.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
Action · 9 steps
01Before submitting any Nplate (romiplostim) claims for Medicare Advantage members.
02Billing team must verify prior authorization is obtained before dispensing—claims will be denied without PA.
03For initial requests, confirm member meets ALL three criteria for cITP (chronic >6 months ITP, platelet count <50 x10⁹/L, documented corticosteroid failure OR post-splenectomy failure).
04For HS-ARS requests, confirm diagnosis of radiation exposure-induced thrombocytopenia.
05Verify member exclusions do NOT apply (no MDS diagnosis, no prior Nplate failure).
06For continuation therapy, confirm platelet count <400 x10⁹/L.
07Request 3-month initial approval and 3-month renewal periods.
08Attach documentation of platelet counts and treatment history with all PA requests.
09Providers must obtain PA before administration to avoid claim denials and therapy interruption.
Original notice
Nplate® (romiplostim) (Revised)
mcp.humana.com · Always check the source before changing claims.