MedicaidPrior AuthMedium impact
Aranesp® (darbepoetin alfa) (Revised)
Humana·SC · Hematology, Oncology, Nephrology +1 more·Medicaid
We identified it
Jul 22, 2026
Summary
Humana has issued a revised Prior Authorization policy for Aranesp® (darbepoetin alfa) affecting Medicare and Medicaid members in South Carolina. The policy updates requirements for prior authorization of this erythropoiesis-stimulating agent. Billing teams must review the specific authorization criteria and implement updated workflows to avoid claim denials.
Action Required
Immediately: Obtain and review the complete revised Aranesp® prior authorization policy from Humana (reference: 090009298a58682a). Billing team must update authorization protocols in billing software to reflect new requirements for CPT/HCPCS code J0881 (darbepoetin alfa injection). Before submitting claims for Aranesp®, verify that prior authorization has been obtained from Humana per the revised policy guidelines. Update claim submission templates and provider education materials to reflect current authorization requirements. Failure to obtain required prior authorization will result in claim denials for South Carolina Medicaid members.