MedicaidPrior AuthMedium impact
Trodelvy (sacituzumab govitecan-hziy) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Trodelvy (sacituzumab govitecan-hziy), an IV cancer medication for specific types of breast cancer. This medication requires prior authorization with specific clinical criteria including disease stage, prior therapy requirements, and exclusions for disease progression.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization process for Trodelvy (sacituzumab govitecan-hziy) IV solution for Humana Medicaid Ohio patients. Verify patient meets specific criteria including cancer type (triple negative or HR-positive/HER2-negative breast cancer), disease stage (unresectable locally advanced or metastatic), and prior therapy requirements before administration. Visit www.humana.com/PAL for medical coding information and submit prior authorization requests through appropriate channels. Claims will be denied without proper authorization.