MedicaidPrior AuthMedium impact
Levoleucovorin products
Humana·OH · Oncology, Orthopedics, Hematology +1 more·Medicaid
Effective date
Sep 24, 2025
We identified it
Aug 6, 2026
Summary
Humana Medicaid Ohio implemented a NEW prior authorization requirement for levoleucovorin products (Khapzory, Fusilev, and generic formulations) effective immediately. Coverage is now limited to three specific indications: osteosarcoma with high-dose methotrexate, impaired methotrexate elimination/overdose, and advanced metastatic colorectal cancer. All three indications require documented failure or intolerance of prior leucovorin calcium therapy before levoleucovorin will be approved.
Action Required
By September 24, 2025 (EFFECTIVE IMMEDIATELY): Billing team must implement prior authorization protocol for all levoleucovorin claims in Medicaid Ohio. (1) Update billing software to flag J0640 and J0641 claims for automatic prior auth submission before processing. (2) Create prior auth checklist requiring: (a) confirmation of qualifying indication (osteosarcoma, MTX toxicity, or metastatic colorectal cancer), (b) documentation that patient has already received prior leucovorin calcium therapy, and (c) clinical evidence of documented side effects from leucovorin calcium (either efficacy failure OR formulation intolerance requiring switch). (3) Train billing staff and providers to screen for exclusion criteria: pernicious anemia or megaloblastic anemia secondary to B12 deficiency (will result in denial). (4) Include dose adjustment guidelines in provider education (normal MTX elimination = 7.5mg IV q6h x 60 hours; delayed elimination = escalate to 75mg IV q1h). (5) Do NOT bill for pediatric patients under 6 years old, hypersensitivity reactions, intrathecal administration, or experimental indications outside CMS compendia. Consequence: Claims submitted without completed prior authorization will be denied by Humana Medicaid Ohio.