Levoleucovorin products (Revised)

REQUIREMENTS: - By October 15, 2025: Billing team must ensure all levoleucovorin product claims (Khapzory, Fusilev, generic levoleucovorin calcium IV solution and powder) for Indiana Medicaid members include prior authorization documentation. - Update billing system to flag all levoleucovorin claims as requiring prior auth before submission. - Clinical documentation team must verify that member charts contain: (1) confirmation of prior leucovorin calcium treatment, and (2) documented evidence of either inadequate efficacy or formulation-related side effects requiring switch to levoleucovorin. - For osteosarcoma cases: Confirm high-dose methotrexate therapy is documented. - For methotrexate toxicity cases: Confirm documented signs of toxicity and prior leucovorin calcium treatment. - For colorectal cancer cases: Confirm advanced metastatic disease, palliative 5-fluorouracil combination chemotherapy, and prior leucovorin calcium treatment. - Screen all submissions for exclusion criteria: reject claims for members with pernicious anemia or megaloblastic anemia secondary to B12 deficiency. - Claims submitted without prior authorization will be denied. Do not bill patients for denied claims due to missing prior auth.