MedicaidPrior AuthMedium impact
Valstar (valrubicin) (New)
Humana·IN · Oncology, Urology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Valstar (valrubicin) intravesical solution, effective May 1, 2026. This medication requires prior approval for treatment of BCG-refractory bladder carcinoma in situ, with specific clinical criteria including disease progression/intolerance to BCG therapy and inability to undergo immediate cystectomy.
Action Required
Before May 1, 2026: Billing team must update prior authorization requirements for Valstar (valrubicin) intravesical solution in billing system for Indiana Medicaid patients. Providers must document that patients meet all three criteria: recurrent/persistent bladder CIS, BCG therapy failure/intolerance, and non-candidacy for immediate cystectomy. Also verify absence of UTI, bladder perforation, or small bladder capacity before treatment. Visit www.humana.com/PAL for specific procedure codes requiring authorization.