Medicare AdvantagePrior AuthMedium impact
Valchlor® (mechlorethamine) (Revised)
Humana·Oncology, Dermatology·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Valchlor (mechlorethamine) prior authorization policy effective January 28, 2026. The revision reinforces existing coverage criteria for fungoides-type cutaneous T-cell lymphoma treatment, with mandatory prior authorization required. Key clinical criteria include documented fungoides-type CTCL diagnosis and prior skin-directed therapy or use as primary treatment. Claims will be denied without prior authorization.
Action Required
By January 28, 2026: Billing team must ensure prior authorization process is active in billing system for all Valchlor (mechlorethamine) claims submitted to Humana Medicare Advantage. Verify that claims submission workflow requires documented evidence of: (1) fungoides-type CTCL diagnosis, and (2) prior skin-directed therapy or notation of primary treatment use. Providers must NOT submit claims without prior authorization approval. Clinical staff should verify member eligibility and document exclusion criteria (disease progression on Valchlor, hypersensitivity, pregnancy status) before authorization request. Update intake forms to capture required clinical documentation. Failure to obtain prior authorization will result in claim denials.