MedicaidPrior AuthMedium impact
Provenge® (sipuleucel-T) (New)
Humana·IN · Oncology, Urology·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for Provenge (sipuleucel-T), an immunotherapy for metastatic castrate-resistant prostate cancer. The policy requires prior auth with specific clinical criteria including ECOG performance status 0-1, asymptomatic/minimally symptomatic disease, and no visceral metastases.
Action Required
Before February 1, 2026: Billing team must update prior authorization workflows for Provenge (sipuleucel-T) intravenous suspension for Indiana Medicaid members. Providers must document ECOG performance status 0-1, confirm asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer, verify absence of visceral disease, and confirm patient does not have Stage I-III prostate cancer or concomitant use with Zytiga or Xtandi. Claims will require prior authorization approval for 6-month periods.