Medicare AdvantagePrior AuthMedium impact
Inlexzo (gemcitabine intravesical system) (New)
Humana·KY, SC, VA · Urology, Oncology·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 24, 2026
Summary
Humana has introduced a new prior authorization policy for Inlexzo (gemcitabine intravesical system), a new treatment for BCG-unresponsive non-muscle invasive bladder cancer. Prior authorization is required for all Medicare and Medicaid members in Kentucky, South Carolina, and Virginia starting December 17, 2025.
Action Required
By December 17, 2025: Billing team must update prior authorization requirements for Inlexzo (gemcitabine intravesical system) in billing system for Humana Medicare and Medicaid members in Kentucky, South Carolina, and Virginia. Providers must verify patient meets all criteria including NMIBC with CIS diagnosis, BCG-unresponsive disease, and ineligibility/refusal for cystectomy before requesting authorization. Claims will be denied without proper prior authorization.