MedicaidPrior AuthMedium impact
Padcev (enfortumab vedotin-ejfv) (New)
Humana·LA · Oncology, Urology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Padcev (enfortumab vedotin-ejfv) for Louisiana Medicaid patients with locally advanced or metastatic bladder cancer. Prior authorization required for both monotherapy and combination therapy with strict criteria including previous platinum-containing chemotherapy and PD-1/PD-L1 inhibitor treatment.
Action Required
Before February 1, 2026: Billing team must implement prior authorization requirements for Padcev (enfortumab vedotin-ejfv) for Louisiana Medicaid patients. Providers must document patient meets criteria including locally advanced/metastatic bladder cancer diagnosis, prior platinum-containing chemotherapy treatment, and previous PD-1/PD-L1 inhibitor therapy OR cisplatin ineligibility with prior therapy lines. Update encounter forms and EMR templates to capture required clinical criteria. Claims without prior authorization will be denied.