MedicaidPrior AuthMedium impact
Folotyn® (pralatrexate)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Folotyn® (pralatrexate) effective January 1, 2026, for treatment of relapsed or refractory peripheral T-cell lymphoma (PTCL). Prior authorization is required for all prescriptions, with a key exclusion: members who have experienced disease progression while on Folotyn will not be approved. Billing teams must implement prior authorization workflows immediately for all Folotyn/pralatrexate claims.
Action Required
By December 31, 2025: Billing team must implement prior authorization requirement for all Folotyn (pralatrexate) intravenous solution claims for Humana Medicaid Ohio members. Update billing system to flag any pralatrexate claims for mandatory prior auth submission before claim processing. Providers must document in clinical records: (1) diagnosis of relapsed or refractory PTCL (specify subtype: peripheral T-cell lymphoma NOS, angioimmunoblastic, anaplastic large cell, or enteropathy-associated), (2) confirmation patient is receiving folic acid and Vitamin B12 supplementation, and (3) no history of disease progression on prior Folotyn therapy. Front desk staff must add prior auth verification step to intake process for any patient presenting with pralatrexate prescriptions. Claims submitted without prior authorization will be denied; claims for members with documented disease progression on Folotyn will not be approved regardless of other clinical factors. Reference Humana's PAL portal at www.humana.com/PAL for updated prior auth procedures and any claim code requirements.