MedicaidPrior AuthMedium impact
Erbitux (cetuximab) (New)
Humana·OH · Oncology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Erbitux (cetuximab) effective February 1, 2026, covering specific colorectal and head/neck cancer indications. Prior authorization will be required for all Erbitux treatments with specific genetic testing and combination therapy requirements.
Action Required
By February 1, 2026: Billing team must update prior authorization workflows for Erbitux (cetuximab) treatments for Ohio Medicaid patients. Ensure genetic testing documentation (BRAF V600E, KRAS G12C, or wild-type RAS status) is obtained before treatment. Update encounter forms to capture required combination therapy details and prior treatment history. Claims will be denied without proper prior authorization.