MedicaidPrior AuthMedium impact
Opdualag™ (nivolumab and relatlimab-rmbw) (New)
Humana·IN · Oncology, Dermatology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Opdualag (nivolumab and relatlimab-rmbw) intravenous solution for Indiana Medicaid patients with unresectable or metastatic melanoma. Requires patients to be 12+ years old, receive monotherapy, and excludes those with disease progression on prior anti-PD-1/PD-L1 combination therapy.
Action Required
Before June 1, 2026: Billing team must update prior authorization system to require approval for Opdualag (nivolumab and relatlimab-rmbw) for Indiana Medicaid patients. Providers must verify patient meets criteria: unresectable/metastatic melanoma diagnosis, age 12+, monotherapy use, and no prior disease progression on anti-PD-1/PD-L1 combination therapy. Initial approvals valid for 6 months.