MedicaidPrior AuthMedium impact
Yondelis® (trabectedin) (Revised)
Humana·LA · Oncology, Palliative Care, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid has revised its prior authorization policy for Yondelis® (trabectedin), an intravenous chemotherapy agent for soft tissue sarcomas. The policy maintains two distinct approval pathways: one for soft tissue sarcoma (including angiosarcoma, rhabdomyosarcoma, and stage IV disease) as monotherapy for palliative treatment, and another for liposarcoma/leiomyosarcoma requiring prior anthracycline therapy. Both pathways exclude members experiencing disease progression on Yondelis. This revised version (effective January 1, 2026, revised June 24, 2026) requires prior authorization before dispensing.
Action Required
By January 1, 2026: Billing and prior authorization team must implement Yondelis (trabectedin) intravenous solution as a prior authorization requirement for Louisiana Medicaid members. (1) Update billing system and prior authorization software to flag all Yondelis claims for PA review before processing. (2) Providers must document one of the following qualifying diagnoses: unresectable/progressive retroperitoneal or intra-abdominal soft tissue sarcoma, angiosarcoma, rhabdomyosarcoma, stage IV soft tissue sarcoma with disseminated metastases, or unresectable/metastatic liposarcoma/leiomyosarcoma with prior anthracycline exposure. (3) Create denial protocol: automatically deny any Yondelis claims for members showing disease progression on the drug. (4) Train prior authorization reviewers on the two distinct approval pathways and exclusion criteria. (5) Verify member Louisiana Medicaid eligibility at time of PA request. Claims submitted without prior authorization approval or for excluded conditions will be denied.