MedicaidPrior AuthMedium impact
Palonosetron IV (Aloxi generics) (Revised)
Humana·OH · Oncology, Anesthesiology, General Surgery·Medicaid
Effective date
Jan 1, 2026
We identified it
Jul 2, 2026
Summary
This is a revised Humana Medicaid Ohio prior authorization policy for Palonosetron IV (generic Aloxi) effective January 1, 2026, with updates as of June 24, 2026. The policy establishes prior authorization requirements for four indications: adult and pediatric chemotherapy-induced nausea/vomiting (CINV) prophylaxis, postoperative nausea/vomiting (PONV) prophylaxis, and PONV treatment. Key changes include clarified age criteria (pediatrics: 1 month to <17 years for MEC/HEC only; adults: ≥17 years for LEC/MEC/HEC; PONV treatment: ≥19 years), and explicit approval durations (plan year for CINV, 3 months for PONV).
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements in billing software for palonosetron IV (HCPCS J2469) for all Humana Medicaid Ohio claims. Update claim submission process to require prior auth for: (1) Adult CINV prophylaxis (age ≥17, receiving LEC/MEC/HEC per NCCN or has refractory CINV), (2) Pediatric CINV prophylaxis (age 1 month to <17, receiving MEC/HEC per NCCN or has refractory CINV), (3) PONV prophylaxis (≤24 hours post-surgery), and (4) PONV treatment (age ≥19, without prior 5-HT3 prophylaxis). Configure system to set initial approval duration to plan year for CINV and 3 months for PONV. Notify providers of age thresholds and emetogenic level requirements. Claims submitted without prior authorization will be denied by Humana Medicaid Ohio.