Medicare AdvantagePrior AuthMedium impact
Levoleucovorin products (Revised)
Humana·KY, SC, VA · Oncology, Hematology, Palliative Care·Medicaid
Effective date
Sep 24, 2025
We identified it
Aug 6, 2026
Summary
Humana revised its Levoleucovorin products prior authorization policy (effective September 24, 2025) covering Medicare and three state Medicaid programs (Kentucky, South Carolina, Virginia). The policy maintains prior authorization requirements for three indications: osteosarcoma with high-dose methotrexate, impaired methotrexate elimination/overdosage, and advanced metastatic colorectal cancer with 5-fluorouracil. Key requirement: members must have documented side effects from leucovorin calcium (either lack of efficacy or formulation issues) to qualify for levoleucovorin substitution.
Action Required
By September 24, 2025: Billing and clinical staff must implement prior authorization workflow for levoleucovorin products (Fusilev, Khapzory, generic levoleucovorin calcium IV solution/powder). Update billing system to flag all levoleucovorin requests for prior auth review. Verify three criteria are met before submission: (1) member is on appropriate therapy (high-dose methotrexate for osteosarcoma, methotrexate/folic acid antagonist with toxicity, or 5-FU chemotherapy for advanced colorectal cancer), (2) member was previously treated with leucovorin calcium, and (3) member has documented side effects from leucovorin calcium efficacy or formulation necessitating switch. Confirm member does NOT have pernicious anemia or megaloblastic anemia secondary to B12 deficiency (exclusion criterion). For Medicare claims, note that Criteria #3 does not apply to medical benefits. Route all intravenous levoleucovorin requests through prior authorization process—claims submitted without prior auth approval will be denied. Approval duration is plan year or per clinical review. Update provider and billing staff training materials with these requirements.