MedicaidPrior AuthMedium impact
Kadcyla (ado-trastuzumab emtansine) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Kadcyla (ado-trastuzumab emtansine) effective January 1, 2026, for Louisiana Medicaid members. This policy requires prior authorization for this expensive breast cancer medication used to treat HER2-positive metastatic and early breast cancer patients.
Action Required
Before January 1, 2026: Medical billing team must establish prior authorization workflow for Kadcyla (ado-trastuzumab emtansine) for Louisiana Medicaid patients. Update billing system to flag this medication for prior auth requirements. Train staff on the specific criteria including HER2-positive status, prior therapy requirements, and exclusion criteria. Coordinate with oncology providers to ensure proper documentation of diagnosis, HER2 status, and treatment history before submitting claims.