MedicaidPrior AuthLow impact
Polivy™ (polatuzumab vedotin-piiq) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Polivy (polatuzumab vedotin-piiq) for Ohio Medicaid patients with diffuse large B-cell lymphoma, requiring approval for both relapsed/refractory and treatment-naive cases with specific clinical criteria.
Action Required
By June 1, 2026: Billing team must implement prior authorization requirements for Polivy (polatuzumab vedotin-piiq) for Ohio Medicaid patients. Ensure providers document diagnosis of diffuse large B-cell lymphoma, prior therapy history, International Prognostic Index scores, and combination therapy plans before submitting claims. Claims without prior authorization will be denied.