MedicaidPrior AuthLow impact
Adstiladrin (nadofaragene firadenovec-vncg) (Revised)
Humana·LA · Urology, Oncology·Medicaid
Effective date
Jan 19, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established a prior authorization policy for Adstiladrin (nadofaragene firadenovec-vncg), a gene therapy for high-risk BCG-unresponsive non-muscle invasive bladder cancer. The policy requires specific criteria including age 18+, carcinoma in situ documentation, and BCG treatment failure before approval.
Action Required
Immediately: Billing team must obtain prior authorization for all Adstiladrin (nadofaragene firadenovec-vncg) claims for Louisiana Medicaid patients. Verify patient meets all four criteria: age 18+, BCG-unresponsive disease, documented carcinoma in situ, and cystectomy ineligibility. Submit prior auth requests through www.humana.com/PAL. Claims without prior authorization will be denied.