MedicaidPrior AuthMedium impact
Jelmyto (mitomycin) (New)
Humana·OH · Oncology, Urology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Jelmyto (mitomycin) effective January 1, 2026, requiring pre-approval for treatment of low-grade upper tract urothelial cancer. The policy requires confirmation of diagnosis criteria and exclusion screening before coverage approval.
Action Required
By January 1, 2026: Billing team must update prior authorization systems to require approval for Jelmyto (mitomycin) prescriptions for Ohio Medicaid members. Providers must verify patient has non-invasive low-grade upper tract urothelial cancer diagnosis and confirm no metastatic disease or urinary tract perforation before prescribing. Submit prior authorization requests through www.humana.com/PAL for medical billing codes. Claims without prior authorization will be denied.