MedicaidPrior AuthMedium impact
Onivyde (liposomal irinotecan) (Revised)
Humana·IN · Oncology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has updated prior authorization requirements for Onivyde (liposomal irinotecan), a cancer treatment for metastatic pancreatic adenocarcinoma. The policy now covers both first-line therapy (with oxaliplatin, fluorouracil and leucovorin) and subsequent therapy (with fluorouracil and leucovorin) but requires specific combination therapies and excludes monotherapy use.
Action Required
By September 1, 2025: Billing team must update prior authorization processes for Onivyde (liposomal irinotecan) for Indiana Medicaid patients with metastatic pancreatic adenocarcinoma. Ensure providers document required combination therapies (oxaliplatin, fluorouracil and leucovorin for first-line; fluorouracil and leucovorin for subsequent therapy) and previous treatment history for subsequent therapy. Update encounter forms to note monotherapy is excluded and prior gemcitabine or fluoropyrimidine therapy is required for subsequent treatment authorization.