MedicaidPrior AuthMedium impact
Inlexzo (gemcitabine intravesical system) (New)
Humana·OH · Urology, 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 Inlexzo (gemcitabine intravesical system) effective February 1, 2026. This drug treats non-muscle invasive bladder cancer in patients who haven't responded to BCG therapy and requires prior authorization with specific clinical criteria.
Action Required
By February 1, 2026: Billing team must implement prior authorization requirements for Inlexzo (gemcitabine intravesical system) for Ohio Medicaid patients. Update billing system to flag these requests and ensure providers document: 1) NMIBC diagnosis with carcinoma in situ, 2) BCG-unresponsive disease with adequate prior BCG therapy, 3) patient ineligibility for or refusal of cystectomy, and 4) absence of bladder perforation. Visit www.humana.com/PAL for specific medical billing codes. Claims without prior authorization will be denied.