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Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Act
by Feb 1, 2026
Effective date
Feb 1, 2026
Identified
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.
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What to do
by Feb 1, 2026 · 5 steps
01Billing team must implement prior authorization requirements for all Keytruda and Keytruda Qlex claims for Louisiana Medicaid members.
02Update billing system to flag these drugs for prior auth.
03Train 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.
04Update encounter forms to include prior auth reminders.
05Claims will be denied without proper prior authorization.
Original notice
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Pembrolizumab products (Keytruda, Keytruda Qlex) (New)HighEffective Nov 1, 2026 · MedicaidPembrolizumab products (Keytruda, Keytruda Qlex) (New)HighEffective Nov 1, 2026 · MedicaidPembrolizumab products (Keytruda, Keytruda Qlex) (New)HighEffective Nov 1, 2026 · MedicaidPembrolizumab products (Keytruda, Keytruda Qlex) (Revised)HighEffective Jan 1, 2025 · MedicaidBrowse every Humana change in the policy list