Medicare AdvantagePrior AuthMedium impact
Elitek® (rasburicase) (Revised)
Humana·FL, KY · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Elitek® (rasburicase) prior authorization policy effective March 25, 2026 for Medicare and Medicaid (Florida and Kentucky). The policy requires prior authorization for rasburicase use in cancer patients at risk for tumor lysis syndrome, with two mandatory approval criteria (malignancy diagnosis + chemotherapy expected to cause TLS) and two critical exclusions (G6PD deficiency and prior hemolytic reactions/methemoglobinemia). No changes to billing codes or reimbursement were identified; this is a clarification/reaffirmation of existing prior auth requirements.
Action Required
By March 25, 2026: Billing and clinical teams must ensure all Elitek® (rasburicase) requests comply with the two-part approval criteria: (1) confirm member has leukemia, lymphoma, or solid tumor malignancy, and (2) verify chemotherapy regimen is expected to cause tumor lysis syndrome. BEFORE submitting prior authorization requests, screen for two critical exclusions: (1) G6PD deficiency status and (2) prior hemolytic reactions or methemoglobinemia to rasburicase. Update prior authorization workflows and templates in billing system to include G6PD screening checklist. Train providers and billing staff that requests missing these exclusion criteria will be denied. Note: This applies ONLY to Medicaid members in Florida and Kentucky, and Medicare members — verify member plan before applying this policy. Do not apply to commercial plans unless separately mandated.