Medicare AdvantagePrior AuthMedium impact
Cytogam® (cytomegalovirus immune globulin, human) (Revised)
Humana·Transplant Surgery, Infectious Disease, Internal Medicine·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Cytogam (cytomegalovirus immune globulin) prior authorization policy effective March 25, 2026. The policy maintains coverage for CMV prophylaxis in five organ transplant types (heart, liver, pancreas, kidney, lung) with consistent prior auth requirements: member must be CMV seronegative AND organ donor must be CMV seropositive. Members with selective IgA deficiency are excluded. Approval duration remains 6 months initial and 6 months for renewal.
Action Required
By March 25, 2026: Verify Humana Medicare Advantage billing system has prior authorization workflow configured for Cytogam IV administration. Ensure authorization requests include verification that: (1) member is CMV seronegative, and (2) organ donor is CMV seropositive. Screening staff and providers must confirm member does NOT have selective IgA deficiency before submission. Claims submitted without documented prior auth for these five transplant indications will be denied. Establish 6-month renewal reminder process in system. Update provider templates and internal documentation checklists to reflect the two-criterion approval pathway.