MedicaidPrior AuthMedium impact
Zevalin® (ibritumomab tiuxetan) (New)
Humana·IN · Oncology, Hematology, Nuclear Medicine +1 more·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Indiana has established a NEW prior authorization policy for Zevalin (ibritumomab tiuxetan), effective February 1, 2026. This is a radioimmunotherapy agent for non-Hodgkin's lymphoma that requires prior auth approval for coverage. The policy limits use to relapsed/refractory low-grade/follicular NHL or previously untreated follicular NHL patients who responded to first-line chemotherapy, with strict eligibility criteria and safety exclusions including bone marrow involvement and platelet/neutrophil thresholds.
Action Required
By February 1, 2026: Billing and clinical staff must implement prior authorization requirements for all Zevalin (ibritumomab tiuxetan) requests for Medicaid Indiana members. (1) Update billing software and claim submission workflows to flag all Zevalin claims for mandatory prior authorization before dispensing. (2) Providers and pharmacy staff must verify member eligibility against the two approved indications: relapsed/refractory low-grade/follicular NHL OR previously untreated follicular NHL with partial/complete response to first-line chemotherapy. (3) Confirm patient meets all safety criteria: age ≥18, not pregnant/breastfeeding, no prior Zevalin therapy, platelet count ≥100,000 cells/mm³, neutrophil count ≥1,500 cells/mm³, <25% lymphoma marrow involvement, and normal bone marrow reserve. (4) Submit prior authorization requests with clinical documentation supporting diagnosis and treatment history. (5) Note the lifetime limit: 1 course per lifetime with 1-month approval duration. Claims submitted without prior authorization approval will be denied. This policy applies only to Medicaid Indiana members; verify plan type before requiring authorization.