Medicare AdvantagePrior AuthMedium impact
Vyxeos™ (daunorubicin and cytarabine) liposome (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Vyxeos (daunorubicin and cytarabine liposome) prior authorization policy effective February 25, 2026. The policy clarifies coverage is limited to newly diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC), with specific approval durations of 6 months per cycle (maximum 2 induction and 2 consolidation cycles). Coverage is denied if members have experienced disease progression on Vyxeos or conventional daunorubicin/cytarabine regimens. This revision updates clinical criteria and approval parameters for Medicaid and Medicare members.
Action Required
By February 25, 2026: Billing and prior authorization teams must implement the updated Vyxeos policy criteria in all PA submission processes. (1) Update PA submission templates to require documentation of t-AML or AML-MRC diagnosis per policy criteria #1. (2) Verify patient disease status meets criteria #2 (newly diagnosed, post-remission, or re-induction use only). (3) Screen all PA requests against exclusion criteria #1 and #2 to deny coverage for patients with documented disease progression on Vyxeos or conventional daunorubicin/cytarabine. (4) Set approval duration limits in billing system: initial and renewal authorizations limited to 6 months (maximum 2 induction cycles + 2 consolidation cycles) unless clinical review determines otherwise. (5) Inform oncology providers of the revised scope and cycle limits to prevent claim denials for out-of-scope uses. (6) Educate front-desk staff and PA coordinators that this policy applies only to Florida, Kentucky, and South Carolina Medicaid plans plus Medicare. Failure to obtain compliant prior authorization will result in claim denials.