Medicare AdvantagePrior AuthMedium impact
Sustol® granisetron (Revised)
Humana·KY, SC · Oncology, Gastroenterology, General Practice·Medicaid
We identified it
Jul 2, 2026
Summary
This is a revised Prior Authorization policy for Sustol® granisetron (granisetron extended-release injection) affecting Medicare, Medicaid - Kentucky, and Medicaid - South Carolina members. The policy update requires billing teams to verify current prior authorization requirements before submitting claims for this antiemetic medication.
Action Required
Immediately: Billing team must obtain and review the complete revised Sustol® granisetron Prior Authorization policy from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5ee). Update billing software and prior authorization workflows to reflect any changes to authorization requirements, medical necessity criteria, or documentation requirements for HCPCS code J1626. Before submitting any Sustol® claims for Kentucky or South Carolina Medicaid members, verify current prior authorization status in the system. Notify providers in oncology and gastroenterology of any new documentation or authorization requirements. Failure to obtain required prior authorization will result in claim denials.