MedicaidPrior AuthHigh impact
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Pembrolizumab products (Keytruda, Keytruda Qlex) for Ohio Medicaid patients effective February 1, 2026. The policy covers 30+ cancer indications with specific clinical criteria and excludes patients who progressed on prior PD-1/PD-L1 therapy.
Action Required
By February 1, 2026: Billing team must update prior authorization procedures for Keytruda/Keytruda Qlex for Ohio Medicaid patients. Providers must document specific clinical criteria including cancer diagnosis, staging, combination therapy requirements, and PD-L1 testing results where required. Update EMR templates to capture required criteria for each of the 30+ covered cancer indications. Claims will require 6-month initial approvals and renewals.