MedicaidPrior AuthMedium impact
Provenge® (sipuleucel-T) (New)
Humana·OH · Oncology, Urology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Provenge (sipuleucel-T), an immunotherapy for advanced prostate cancer. Effective February 1, 2026, providers must obtain prior authorization demonstrating patients have asymptomatic/minimally symptomatic metastatic castrate-resistant prostate cancer with specific performance status and exclusion criteria.
Action Required
Before February 1, 2026: Billing team must implement prior authorization requirements for Provenge (sipuleucel-T) for Humana Medicaid Ohio members. Update billing system to flag these cases and create workflow for providers to document ECOG performance status 0-1, absence of visceral disease, and verify patient does not have Stage I-III prostate cancer or concurrent use of Zytiga/Xtandi. Claims without prior auth will be denied.