MedicaidPrior AuthMedium impact
Enhertu (fam-trastuzumab deruxtecan-nxki) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Enhertu (fam-trastuzumab deruxtecan-nxki), an oncology drug used for various HER2-positive cancers including breast, gastric, lung, and other solid tumors. The policy defines specific criteria for coverage across six different cancer indications, all requiring prior authorization approval for plan year duration.
Action Required
Before June 1, 2026: Billing team must update prior authorization workflow for Enhertu (fam-trastuzumab deruxtecan-nxki) for Indiana Medicaid patients. Providers must obtain prior auth by documenting specific HER2 status, cancer stage, prior treatments, and meeting indication-specific criteria before prescribing. Create alerts in EMR for oncology providers treating breast cancer, gastric cancer, lung cancer, and other HER2-positive solid tumors. Claims will be denied without proper prior authorization.