Medicare AdvantagePrior AuthMedium impact
Folotyn® (pralatrexate) (Revised)
Humana·FL, SC · Oncology, Hematology·Medicaid
We identified it
Aug 12, 2026
Summary
This is a revised Prior Authorization policy for Folotyn® (pralatrexate) affecting Medicare, Medicaid-Florida, and Medicaid-South Carolina members. The policy update requires prior authorization review before dispensing this medication. No specific effective date or detailed policy content is available in this summary-only source.
Action Required
Immediately: Billing and pharmacy teams must obtain the full policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5a1388) to identify specific prior authorization requirements, covered diagnoses, and documentation needed for Folotyn® claims. Update billing system and pharmacy workflows to flag all Folotyn® prescriptions for prior authorization review before claim submission or dispensing. Ensure providers in Florida and South Carolina are notified of the revised requirements. Claims submitted without prior authorization will likely be denied.