MedicaidPrior AuthMedium impact
Datroway (datopotamab deruxtecan-dlnk) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Datroway (datopotamab deruxtecan-dlnk), a cancer treatment drug for HR-positive/HER2-negative breast cancer and EGFR-mutated non-small cell lung cancer. Prior authorization is required with specific clinical criteria including prior therapy requirements.
Action Required
By November 1, 2025: Billing team must update prior authorization procedures for Datroway (datopotamab deruxtecan-dlnk) for Humana Medicaid Ohio patients. Providers must document specific clinical criteria including cancer diagnosis, prior therapy history, and treatment plan before prescribing. Visit www.humana.com/PAL for medical and procedural coding information. Claims without proper prior authorization will be denied.