MedicaidPrior AuthHigh impact
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Pembrolizumab products (Keytruda and Keytruda Qlex) for Louisiana Medicaid members effective February 1, 2026. The policy covers 31 different cancer indications with specific criteria, combination therapy requirements, and 6-month approval durations.
Action Required
By February 1, 2026: Billing team must implement prior authorization requirements for all Keytruda and Keytruda Qlex claims for Louisiana Medicaid members. Update billing system to flag these drugs for prior auth. Train providers on specific criteria for each of the 31 covered cancer indications including required biomarker testing (PD-L1, MSI-H, dMMR) and combination therapy requirements. Update encounter forms to include prior auth reminders. Claims will be denied without proper prior authorization.