MedicaidPrior AuthMedium impact
Non-Preferred Filgrastim Products (Revised)
Humana·KY, SC · Hematology, Oncology·Medicaid
We identified it
Jul 14, 2026
Summary
Humana has revised its Prior Authorization policy for non-preferred Filgrastim products affecting Medicaid members in Kentucky and South Carolina. This policy change requires billing teams to verify authorization requirements before claims submission for these hematopoietic agents.
Action Required
Immediately: Billing team must review the complete revised policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a57b94d to identify specific prior authorization triggers for non-preferred Filgrastim products (J1440, J1441). Update billing software and encounter workflows to require prior authorization verification for Kentucky and South Carolina Medicaid members before claim submission. Contact Humana directly to confirm effective date and implementation requirements. Failure to obtain prior authorization will result in claim denials. Flag all pending Filgrastim claims for KY and SC Medicaid for authorization status review.