MedicaidPrior AuthMedium impact
Provenge® (sipuleucel-T) (New)
Humana·LA · Oncology, Urology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Provenge® (sipuleucel-T) immunotherapy for Louisiana Medicaid patients with metastatic castrate-resistant prostate cancer, effective February 1, 2026. Strict eligibility criteria include asymptomatic/minimally symptomatic disease, ECOG performance status 0-1, and no visceral metastases.
Action Required
Before February 1, 2026: Billing team must update prior authorization workflow for Provenge (sipuleucel-T) for Louisiana Medicaid patients. Providers must document ECOG performance status 0-1, confirm asymptomatic/minimally symptomatic metastatic castrate-resistant prostate cancer, and verify absence of visceral disease. Add checklist to EMR template for required criteria. Claims will be denied without proper prior authorization.