Medicare AdvantagePrior AuthMedium impact
Nplate® (romiplostim) (Revised)
Humana·SC · Hematology, Oncology·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Nplate® (romiplostim) affecting Medicare and Medicaid—South Carolina members. The billing team must implement updated prior authorization requirements for this medication. Without access to the full policy content, specific changes cannot be detailed, but this revision supersedes any previous Nplate® guidance.
Action Required
Immediately: Billing team and providers must obtain prior authorization for all Nplate® (romiplostim) claims for South Carolina Medicaid and Medicare members before submission. Update billing system rules and encounter templates to flag Nplate® prescriptions for prior auth review. Contact Humana at the policy source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a58681e) to obtain complete policy details including specific approval criteria, documentation requirements, and effective date. Claims submitted without required prior authorization will be denied. This policy supersedes all previous Nplate® guidance.