MedicaidPrior AuthMedium impact
Padcev (enfortumab vedotin-ejfv) (New)
Humana·OH · Oncology, Urology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Padcev (enfortumab vedotin-ejfv), an intravenous cancer treatment for locally advanced or metastatic bladder cancer. The policy requires specific criteria to be met including prior treatment history and clinical eligibility before approval.
Action Required
Before February 1, 2026: Billing team must update prior authorization requirements for Padcev (enfortumab vedotin-ejfv) for Humana Medicaid Ohio members. Providers must verify patients meet criteria including prior platinum-containing chemotherapy and PD-1/PD-L1 inhibitor treatment or cisplatin ineligibility before prescribing. Submit prior authorization requests through www.humana.com/PAL. Claims without prior authorization will be denied.