MedicaidPrior AuthMedium impact
Mylotarg® (gemtuzumab ozogamicin) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented a new prior authorization policy for Mylotarg (gemtuzumab ozogamicin), a specialty cancer drug for acute myeloid leukemia. Prior authorization is now required with specific criteria including CD33-positive disease confirmation and age restrictions based on disease status.
Action Required
Before February 1, 2026: Billing team must update prior authorization procedures for Mylotarg (gemtuzumab ozogamicin) for Indiana Medicaid patients. Ensure providers document: 1) AML diagnosis, 2) CD33-positive disease status, 3) Patient age and disease status (newly diagnosed patients 1+ months old OR relapsed/refractory patients 2+ years old). Add prior auth requirements to oncology encounter forms and EMR templates. Claims will be denied without proper prior authorization.