Medicare AdvantagePrior AuthMedium impact
Anktiva (nogapendekin alfa inbakicept-pmln) (Revised)
Humana·FL, KY, SC · Urology, Oncology·Medicaid
Effective date
Jun 26, 2024
We identified it
Jun 24, 2026
Summary
Humana has established new prior authorization requirements for Anktiva (nogapendekin alfa inbakicept-pmln), a new intravesical treatment for BCG-unresponsive non-muscle invasive bladder cancer. The policy requires specific clinical criteria including age 18+, documented carcinoma in situ, BCG-unresponsive disease, and concurrent use with BCG therapy.
Action Required
Immediately: Billing team must implement prior authorization requirements for Anktiva (nogapendekin alfa inbakicept-pmln) requests. Providers treating non-muscle invasive bladder cancer must document all five clinical criteria: patient age 18+, CIS diagnosis, BCG-unresponsive disease with adequate prior BCG therapy, cystectomy ineligibility/refusal, and concurrent BCG use. Initial approvals limited to 6 months with 6-month renewals. Claims will be denied without proper prior authorization.