MedicaidPrior AuthMedium impact
Libtayo® (cemiplimab-rwlc) (New)
Humana·OH · Oncology, Dermatology, Pulmonology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established new prior authorization requirements for Libtayo (cemiplimab-rwlc), a cancer immunotherapy drug used for skin cancers and lung cancer. The policy requires specific clinical criteria to be met before approval, including diagnosis confirmation, treatment history, and exclusions for patients who failed previous PD-1/PD-L1 inhibitors.
Action Required
Before February 1, 2026: Billing team and providers must implement prior authorization process for all Libtayo (cemiplimab-rwlc) requests for Humana Medicaid Ohio patients. Providers must document specific criteria including diagnosis type, disease staging, prior treatments, and PD-L1 expression levels for lung cancer cases. Update EMR templates to capture required clinical information and establish workflow to submit prior authorization requests before treatment initiation.