MedicaidPrior AuthMedium impact
Folotyn® (pralatrexate)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Louisiana Medicaid has implemented a new prior authorization policy for Folotyn® (pralatrexate) effective January 1, 2026. This policy requires prior authorization for all Folotyn use in treating relapsed or refractory peripheral T-cell lymphoma (PTCL), with approval denied if the patient has experienced disease progression while on the drug. The policy mandates that patients receive folic acid and Vitamin B12 supplementation before and during treatment.
Action Required
By December 31, 2025: Billing team and clinical staff must implement prior authorization procedures for all Folotyn (pralatrexate) claims for Louisiana Medicaid members. (1) Update billing system to flag all pralatrexate intravenous solution claims (brand Folotyn and generic) for prior authorization submission before claim submission. (2) Create internal checklist requiring verification that patient has documented: (a) diagnosis of relapsed or refractory PTCL, (b) NO prior disease progression on Folotyn, (c) concurrent folic acid and Vitamin B12 supplementation orders. (3) Instruct providers to document indication as one of: peripheral T-cell lymphoma NOS, angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma, or enteropathy-associated T-cell lymphoma. (4) Route all prior auth requests through Humana's Preauthorization and Notification List (PAL) portal at www.humana.com/PAL. Claims submitted without prior authorization will be denied; claims for patients with documented disease progression while on Folotyn will be denied even with prior auth.