Medicare AdvantagePrior AuthMedium impact
Sancuso® (granisetron) transdermal patch (Revised)
Humana·Oncology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jul 2, 2026
Summary
This is a revised Medicare Advantage prior authorization policy for Sancuso (granisetron) transdermal patch effective January 1, 2025. The policy establishes two coverage pathways: (1) prevention of chemotherapy-induced nausea/vomiting for patients receiving highly or moderately emetogenic chemotherapy, and (2) breakthrough treatment when added to existing regimen without prior 5-HT3 receptor antagonist use in the same cycle. Prior authorization is required for all Sancuso coverage under this plan.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirements for all Sancuso (granisetron) transdermal patch claims for Medicare Advantage members. (1) Update billing system to flag Sancuso prescriptions for mandatory prior auth submission before dispensing. (2) Create prior auth request template requiring documentation of: chemotherapy regimen emetogenic level (highly or moderately emetogenic), indication (prevention vs. breakthrough), and for breakthrough cases, confirmation that member has not received 5-HT3 antagonist in current chemotherapy cycle. (3) Train providers and staff to obtain prior auth before submitting claims. (4) Verify member's Medicare Advantage plan status at time of service. (5) Communicate policy to all oncology providers and infusion centers. Claims submitted without prior authorization will be denied. Reference policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5ec or verify current version at www.humana.com/PAL before processing requests.