MedicaidPrior AuthMedium impact
Jemperli (dostarlimab-gxly) (New)
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 Jemperli (dostarlimab-gxly), a cancer immunotherapy drug, effective November 1, 2025, for Indiana Medicaid patients. The policy covers three main indications: frontline endometrial cancer therapy, second-line endometrial cancer treatment, and certain solid tumors with mismatch repair deficiency.
Action Required
By November 1, 2025: Billing and clinical teams must implement prior authorization requirements for all Jemperli (dostarlimab-gxly) requests for Indiana Medicaid patients. Update EMR templates to capture required clinical criteria including cancer diagnosis, prior treatments, and biomarker testing (dMMR status). Train providers to document specific combination therapy protocols and exclusion criteria. Visit www.humana.com/PAL for medical coding information and submission procedures.