MedicaidPrior AuthMedium impact
Enhertu (fam-trastuzumab deruxtecan-nxki) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has established a new prior authorization policy for Enhertu (fam-trastuzumab deruxtecan-nxki), a targeted cancer therapy used for various HER2-positive/low cancers including breast, lung, gastric, and other solid tumors. The policy outlines specific clinical criteria that must be met for approval across six different cancer indications.
Action Required
Before June 1, 2026: Oncology billing team must update prior authorization procedures for Enhertu (fam-trastuzumab deruxtecan-nxki) for Louisiana Medicaid patients. Review each of the six covered indications (HER2-positive breast cancer, HER2-low breast cancer, HER2-ultralow breast cancer, gastric/GEJ adenocarcinoma, HER2-mutant NSCLC, and HER2-positive solid tumors) and ensure documentation meets specific clinical criteria before submitting authorization requests. Update EMR templates to capture required diagnostic markers (IHC status, prior treatments, disease staging). Claims will be denied without proper prior authorization.