MedicaidPrior AuthMedium impact
Polivy™ (polatuzumab vedotin-piiq) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Polivy™ (polatuzumab vedotin-piiq), a cancer drug used to treat diffuse large B-cell lymphoma. This policy requires prior authorization for both relapsed/refractory cases and treatment-naive cases, with specific clinical criteria that must be met for approval.
Action Required
Before June 1, 2026: Billing team must update prior authorization requirements for Polivy™ (polatuzumab vedotin-piiq) infusions for Indiana Medicaid patients. Providers must ensure patients meet specific clinical criteria including diagnosis confirmation, prior therapy requirements, and combination therapy protocols before submitting authorization requests. Update EMR templates to capture required documentation for lymphoma diagnosis, International Prognostic Index scores, and treatment history.