MedicaidPrior AuthMedium impact
Datroway (datopotamab deruxtecan-dlnk) (New)
Humana·IN · Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Datroway (datopotamab deruxtecan-dlnk), a newly approved cancer treatment for HR-positive/HER2-negative breast cancer and EGFR-mutated non-small cell lung cancer. This affects Indiana Medicaid patients requiring specific criteria including prior treatments with endocrine therapy, chemotherapy, and EGFR-directed therapy.
Action Required
By November 1, 2025: Billing and clinical teams must implement prior authorization requirements for Datroway (datopotamab deruxtecan-dlnk) for Indiana Medicaid patients. Verify patients meet specific diagnosis criteria (unresectable/metastatic HR-positive/HER2-negative breast cancer OR locally advanced/metastatic EGFR-mutated NSCLC), document prior treatment history (endocrine therapy and chemotherapy for breast cancer; EGFR-directed therapy and platinum-based chemotherapy for lung cancer), and obtain prior authorization through Humana's system. Visit www.humana.com/PAL for medical coding information. Claims without proper authorization will be denied.