MedicaidPrior AuthMedium impact
Kadcyla (ado-trastuzumab emtansine) (New)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Indiana Medicaid has implemented a new prior authorization policy for Kadcyla (ado-trastuzumab emtansine), a specialty cancer drug used to treat HER2-positive breast cancer. This policy establishes specific criteria for both metastatic and early breast cancer treatment approval, requiring prior therapy documentation and HER2-positive status confirmation.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Kadcyla (ado-trastuzumab emtansine) claims for Indiana Medicaid patients. Update billing system to flag this medication for prior auth. Ensure providers document HER2-positive status, prior therapy history (trastuzumab and taxane), and specific indication (metastatic vs. early breast cancer) before administration. Claims without prior authorization will be denied.