MedicaidPrior AuthMedium impact
Poteligeo® (mogamulizumab-kpkc) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Poteligeo (mogamulizumab-kpkc), an IV cancer treatment for mycosis fungoides or Sézary syndrome. Prior authorization is required for all Medicaid members in Indiana receiving this specialty oncology drug.
Action Required
Before March 1, 2026: Billing team must update prior authorization workflows for Poteligeo (mogamulizumab-kpkc) for Indiana Medicaid members with mycosis fungoides or Sézary syndrome. Verify patients meet all three criteria: diagnosis confirmation, relapsed/refractory disease, and use as sole systemic therapy. Visit www.humana.com/PAL for medical billing codes. Claims will be denied without proper prior authorization.