MedicaidPrior AuthLow impact
Inlexzo (gemcitabine intravesical system) (New)
Humana·IN · Urology, Oncology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has established a new prior authorization policy for Inlexzo (gemcitabine intravesical system), a new treatment for high-risk, BCG-unresponsive non-muscle invasive bladder cancer. The policy requires documentation of specific criteria including carcinoma in situ diagnosis, BCG treatment failure, and patient ineligibility or refusal for cystectomy.
Action Required
Before February 1, 2026: Billing and prior authorization staff must establish workflow for Inlexzo prior authorization requests. Document required criteria: NMIBC with carcinoma in situ diagnosis, evidence of BCG-unresponsive disease with adequate BCG therapy documentation, and patient cystectomy status. Visit www.humana.com/PAL for medical coding information when submitting requests.