Medicare AdvantagePrior AuthMedium impact
Akynzeo (fosnetupitant-palonosetron/netupitant- palonosetron) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 1, 2026
Summary
Humana Medicare Advantage revised its Akynzeo (fosnetupitant-palonosetron/netupitant-palonosetron) prior authorization policy effective January 1, 2026, with updates as of June 24, 2026. For oral capsules, prior authorization now requires documented failure, contraindication, or significant side effects with aprepitant before Akynzeo approval. Both oral and IV formulations require use with highly emetogenic or moderately emetogenic chemotherapy. This is a revised policy that supersedes any previous Akynzeo guidance.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization requirements for all Akynzeo claims submitted to Humana Medicare Advantage. For oral capsule formulations (netupitant-palonosetron), ensure providers document one of the following in authorization requests: (1) prior treatment failure with aprepitant at FDA-indicated dose, (2) contraindication to aprepitant, or (3) significant side effects from aprepitant necessitating alternative therapy. For both oral and IV formulations, verify chemotherapy regimen is classified as highly emetogenic (HEC) or moderately emetogenic (MEC) before submitting authorization. Update EMR templates and prior authorization submission forms to capture required clinical documentation. Flag claims lacking documented aprepitant trial/contraindication/side effects for oral products as incomplete and request additional documentation from providers. Communicate with oncology practices regarding the revised aprepitant failure-first requirement for capsule formulations. Monitor for claim denials and educate providers on new criteria to prevent revenue cycle delays.