MedicaidPrior AuthMedium impact
Kadcyla (ado-trastuzumab emtansine) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Kadcyla (ado-trastuzumab emtansine) for Ohio Medicaid patients with breast cancer, effective January 1, 2026. The policy requires specific criteria to be met for both metastatic and early breast cancer patients, including HER2-positive status and prior therapy requirements.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Kadcyla (ado-trastuzumab emtansine) for Ohio Medicaid patients. Providers must document HER2-positive status, prior therapy with trastuzumab and taxane, and ensure patients meet specific criteria for metastatic or early breast cancer. Update encounter forms and EMR templates to capture required documentation. Claims will be denied without proper prior authorization.