Medicare AdvantagePrior AuthMedium impact
Datroway (datopotamab deruxtecan-dlnk) (Revised)
Humana·KY, SC · Oncology·Medicaid
Effective date
Mar 26, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Datroway (datopotamab deruxtecan-dlnk), a cancer treatment drug for HR-positive/HER2-negative breast cancer and EGFR-mutated non-small cell lung cancer. Prior authorization will be required for Medicare and Medicaid plans in Kentucky and South Carolina starting March 26, 2025.
Action Required
By March 26, 2025: Billing team must update prior authorization procedures for Datroway (datopotamab deruxtecan-dlnk) for Humana Medicare and Medicaid members in Kentucky and South Carolina. Verify patient diagnosis criteria (breast cancer: HR-positive/HER2-negative with prior endocrine and chemotherapy; NSCLC: EGFR-mutated with prior EGFR-directed and platinum-based therapy) before treatment. Submit prior authorization requests through www.humana.com/PAL. Claims will be denied without proper authorization.