MedicaidPrior AuthMedium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Epkinly (epcoritamab-bysp), a specialized cancer treatment for certain lymphomas, affecting Indiana Medicaid patients. The policy requires prior authorization for this high-cost oncology medication with specific clinical criteria and exclusions that must be met for approval.
Action Required
By November 1, 2025: Oncology practices treating Indiana Medicaid patients must obtain prior authorization before prescribing Epkinly (epcoritamab-bysp) for DLBCL, high-grade B-cell lymphoma, or follicular lymphoma. Update prior authorization workflows to verify patients meet specific criteria including prior systemic therapy requirements and absence of CNS involvement. Claims without prior authorization will be denied.