MedicaidPrior AuthMedium impact
Opdualag™ (nivolumab and relatlimab-rmbw) (New)
Humana·OH · Oncology, Dermatology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Opdualag (nivolumab and relatlimab-rmbw), a combination immunotherapy for treating unresectable or metastatic melanoma in patients 12 years and older. Prior authorization is required with specific criteria including diagnosis confirmation, age requirements, and monotherapy administration, with 6-month approval periods.
Action Required
Before June 1, 2026: Billing team must update prior authorization workflows for Opdualag (nivolumab and relatlimab-rmbw) for Ohio Medicaid patients. Ensure providers document unresectable or metastatic melanoma diagnosis, patient age 12+, and monotherapy use. Add prior auth requirement to billing system for this drug. Claims will be denied without proper authorization.