MedicaidPrior AuthMedium impact
Unituxin (dinutuximab) (Revised)
Humana·LA · Oncology, Pediatrics, Pharmacy·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Unituxin (dinutuximab) for Louisiana Medicaid members with high-risk neuroblastoma. Requires specific criteria including age under 18, combination therapy with isotretinoin and alternating cycles of sargramostim and aldesleukin, plus previous induction chemotherapy and stem cell transplantation.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Unituxin (dinutuximab) for Louisiana Medicaid members. Verify patients meet all 6 criteria including high-risk neuroblastoma diagnosis, age under 18, combination therapy requirements, and previous treatments. Update billing system to flag this medication for prior auth. Claims will be denied without proper authorization.