MedicaidPrior AuthMedium impact
Margenza (margetuximab-cmkb) (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 Margenza (margetuximab-cmkb), a cancer drug for metastatic HER2-positive breast cancer. The policy requires specific criteria including prior anti-HER2 therapies and combination with chemotherapy.
Action Required
By November 1, 2025: Billing team must update prior authorization requirements for Margenza (margetuximab-cmkb) for Louisiana Medicaid patients. Ensure documentation includes metastatic breast cancer diagnosis, HER2-positive status, two prior anti-HER2 therapies (one in metastatic setting), and combination chemotherapy use. Add prior auth checklist to oncology encounter forms.