MedicaidPrior AuthMedium impact
Pemetrexed Products (New)
Humana·IN · Oncology, Hematology, Pulmonology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established a new prior authorization policy for pemetrexed products (including Alimta, Pemfexy, and Axtle) effective November 1, 2025. Prior authorization is required for malignant pleural mesothelioma and non-squamous non-small cell lung cancer, with specific criteria including creatinine clearance requirements and treatment combination protocols.
Action Required
Before November 1, 2025: Billing team must implement prior authorization requirements for all pemetrexed products (Alimta, Pemfexy, Axtle) for Humana Medicaid Indiana members. Update billing system to flag these medications and ensure providers document diagnosis of malignant pleural mesothelioma or non-squamous NSCLC, creatinine clearance ≥45 ml/minute, and appropriate treatment combinations. Claims will be denied without proper prior authorization.