MedicaidPrior AuthLow impact
Jelmyto (mitomycin) (New)
Humana·IN · Oncology, Urology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana is implementing a new prior authorization policy for Jelmyto (mitomycin), a specialized cancer medication used to treat low-grade upper tract urothelial cancer. Prior authorization will be required starting January 1, 2026, with specific clinical criteria including non-metastatic disease and no bladder perforation.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for Jelmyto (mitomycin) prescriptions for Indiana Medicaid patients. Verify patient meets criteria (non-invasive low-grade upper tract urothelial cancer, non-metastatic disease, no bladder/urinary tract perforation) before submitting prior auth requests. Visit www.humana.com/PAL for specific medical billing codes and preauthorization requirements.