MedicaidPrior AuthMedium impact
Onivyde (liposomal irinotecan) (Revised)
Humana·OH · Oncology, Gastroenterology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated their prior authorization policy for Onivyde (liposomal irinotecan) for Ohio Medicaid patients with metastatic pancreatic cancer. The policy now covers both first-line and subsequent therapy with specific combination requirements and excludes monotherapy use.
Action Required
By September 1, 2025: Billing team must ensure prior authorization is obtained for all Onivyde (liposomal irinotecan) prescriptions for Ohio Medicaid patients with metastatic pancreatic cancer. Update pharmacy billing protocols to verify combination therapy requirements (oxaliplatin + fluorouracil + leucovorin for first-line; fluorouracil + leucovorin for subsequent therapy) and document previous gemcitabine or fluoropyrimidine therapy failure for subsequent treatment. Monotherapy requests will be denied.