MedicaidPrior AuthMedium impact
Yondelis® (trabectedin) (Revised)
Humana·OH · Oncology, Hematology, Palliative Care·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Ohio updated the Yondelis (trabectedin) prior authorization policy effective January 1, 2026, with a revision date of June 24, 2026. The policy establishes specific clinical criteria for coverage of this intravenous chemotherapy drug for soft tissue sarcomas, liposarcomas, and leiomyosarcomas. Billing teams must ensure all Yondelis claims for Ohio Medicaid members undergo prior authorization review before dispensing.
Action Required
By January 1, 2026: Billing and pharmacy teams must implement prior authorization requirements for all Yondelis (trabectedin/HCPCS J9352) claims for Humana Medicaid Ohio members. Update billing system to flag Yondelis intravenous solution claims and route to prior authorization workflow. Ensure providers submit prior authorization requests with documented diagnosis (unresectable/progressive soft tissue sarcoma, liposarcoma, leiomyosarcoma, angiosarcoma, rhabdomyosarcoma, or stage IV disease) and evidence of prior anthracycline therapy when applicable. Train clinical staff to verify disease progression exclusion criteria before approval. Communicate policy changes to all oncology and hematology providers billing Humana Medicaid Ohio. Claims submitted without prior authorization or not meeting clinical criteria will be denied.