MedicaidPrior AuthMedium impact
Erbitux (cetuximab) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Erbitux (cetuximab) for Louisiana Medicaid patients effective February 1, 2026. Coverage requires specific criteria based on cancer type and genetic mutations, with strict exclusions for patients who have progressed on prior EGFR inhibitor therapy.
Action Required
By February 1, 2026: Oncology team must establish prior authorization workflow for Erbitux (cetuximab) for Louisiana Medicaid patients. Ensure genetic testing documentation (BRAF V600E, KRAS G12C, or wild-type RAS status) is available before requesting authorization. Update treatment protocols to verify combination therapy requirements and exclude patients with prior progression on Vectibix or Erbitux. Claims will be denied without proper prior authorization.