MedicaidPrior AuthMedium impact
Margenza (margetuximab-cmkb) (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 requirement for Margenza (margetuximab-cmkb), a cancer drug for metastatic HER2-positive breast cancer patients who have received at least 2 prior anti-HER2 therapies. Prior authorization must be obtained before administering this medication.
Action Required
Before November 1, 2025: Billing team must implement prior authorization requirements for Margenza (margetuximab-cmkb) for Ohio Medicaid patients. Update billing system to flag this medication and require prior auth approval before administration. Providers must document metastatic breast cancer diagnosis, HER2-positive status, two prior anti-HER2 therapies (including one in metastatic setting), and combination with approved chemotherapy. Claims will be denied without proper prior authorization.