MedicaidPrior AuthMedium impact
Pemetrexed Products (New)
Humana·LA · Oncology, Pulmonology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established new prior authorization requirements for pemetrexed products (including Alimta, Pemfexy, Pemrydi RTU, and Axtle) used to treat malignant pleural mesothelioma and non-squamous non-small cell lung cancer. The policy requires specific diagnostic criteria to be met and excludes patients with creatinine clearance below 45 ml/minute.
Action Required
Before November 1, 2025: Billing team must update prior authorization workflow for pemetrexed products (Alimta, Pemfexy, Pemrydi RTU, Axtle) for Louisiana Medicaid patients. Providers must document diagnosis of malignant pleural mesothelioma or non-squamous NSCLC, ensure creatinine clearance ≥45 ml/minute, and obtain prior authorization before administration. Claims will be denied without proper prior authorization.