Medicare AdvantagePrior AuthMedium impact
Levoleucovorin products (Revised)
Humana·KY, SC, VA · Oncology, Hematology·Medicaid
Effective date
Aug 26, 2026
We identified it
Aug 25, 2026
Summary
This revised Humana pharmacy policy on levoleucovorin products (Khapzory, Fusilev, and generic formulations) maintains prior authorization requirements for three indications: osteosarcoma with high-dose methotrexate, impaired methotrexate elimination/overdosage, and advanced metastatic colorectal cancer. The policy was revised on August 26, 2026 (1 day old) and applies to Medicare and three state Medicaid programs. Key change: approval now requires documented failure or intolerance of prior leucovorin calcium therapy for all three indications, with specific exclusions for pernicious anemia and B12-deficiency anemias.
Action Required
By August 26, 2026: Billing and prior authorization teams must update internal systems to enforce the revised criteria for levoleucovorin products across all three clinical scenarios. Specifically: (1) For osteosarcoma cases—require documentation that member has failed leucovorin calcium therapy due to documented side effects or formulation intolerance before approving levoleucovorin; (2) For methotrexate toxicity cases—verify prior leucovorin calcium treatment failure with documented adverse effects; (3) For colorectal cancer—confirm prior leucovorin calcium inefficacy with side effect documentation. Billing team must screen all levoleucovorin claims to verify member does NOT have pernicious anemia or B12-deficiency megaloblastic anemia (automatic exclusion). Update prior authorization workflow in Humana portal and internal billing software. Educate providers and clinical staff on the stricter documentation requirements. Claims submitted without evidence of prior leucovorin calcium failure or with excluded conditions will be denied. This applies only to Kentucky, South Carolina, and Virginia Medicaid and Medicare lines of business.