MedicaidPrior AuthMedium impact
Valstar (valrubicin) (New)
Humana·LA · Urology, Oncology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Valstar (valrubicin) intravesical solution, used to treat BCG-refractory bladder cancer. The policy requires prior authorization with specific clinical criteria including recurrent/persistent carcinoma in situ, BCG therapy failure/intolerance, and exclusions for active UTI or bladder perforation.
Action Required
Before May 1, 2026: Billing team must update prior authorization systems to require approval for Valstar (valrubicin) intravesical solution for Louisiana Medicaid patients. Providers must document BCG therapy failure/intolerance, confirm patient is not a cystectomy candidate, and verify absence of UTI or bladder perforation. Visit www.humana.com/PAL for specific medical billing codes requiring prior authorization.