MedicaidPrior AuthMedium impact
Datroway (datopotamab deruxtecan-dlnk) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Datroway (datopotamab deruxtecan-dlnk), a cancer treatment for HR-positive/HER2-negative breast cancer and EGFR-mutated non-small cell lung cancer. Prior authorization will be required starting November 1, 2025, with specific clinical criteria that must be met for approval.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Datroway (datopotamab deruxtecan-dlnk) for Louisiana Medicaid patients. Update billing system to flag this medication for prior auth. Providers must verify patients meet specific clinical criteria including prior therapy requirements and disease staging before ordering. Visit www.humana.com/PAL for medical coding information and prior authorization submission process.