MedicaidPrior AuthMedium impact
Pemetrexed Products (New)
Humana·OH · Oncology, Hematology, Pulmonology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for all pemetrexed products (including Alimta, Pemfexy, Pemrydi RTU, and Axtle) effective November 1, 2025. This requires prior approval for treatment of malignant pleural mesothelioma and non-squamous non-small cell lung cancer, with specific clinical criteria and exclusions including creatinine clearance requirements.
Action Required
By November 1, 2025: Billing team must update prior authorization workflows for all pemetrexed products (pemetrexed disodium, Alimta, Pemfexy, Pemrydi RTU, Axtle) for Humana Medicaid Ohio members. Providers must obtain prior auth by documenting diagnosis of malignant pleural mesothelioma or non-squamous NSCLC, treatment combination details, and confirming creatinine clearance ≥45 ml/minute. Claims will be denied without proper prior authorization.