MedicaidPrior AuthMedium impact
Yondelis® (trabectedin) (Revised)
Humana·IN · Oncology, Pharmacy·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Indiana Medicaid has revised its prior authorization policy for Yondelis® (trabectedin), an intravenous chemotherapy agent for soft tissue sarcomas and liposarcoma/leiomyosarcoma. The policy establishes specific clinical criteria for approval, including diagnosis requirements and prior treatment history (anthracycline exposure for liposarcoma/leiomyosarcoma cases), with disease progression on Yondelis as an exclusion criterion. Billing teams must implement prior authorization requirements for all Yondelis infusions under this plan effective immediately.
Action Required
By January 1, 2026 (or immediately upon implementation): Billing team must update systems to require prior authorization for all Yondelis (trabectedin) intravenous solution claims for Indiana Medicaid members. Create or update prior authorization submission workflows to verify: (1) For soft tissue sarcoma cases—confirm diagnosis of unresectable/progressive retroperitoneal/intraabdominal disease, angiosarcoma, rhabdomyosarcoma, or stage IV extremity/superficial trunk disease with recurrent/metastatic disease; (2) For liposarcoma/leiomyosarcoma cases—confirm unresectable/metastatic diagnosis AND prior anthracycline-containing chemotherapy. Flag and deny any claims where member has experienced disease progression on Yondelis. Update prior authorization request templates and provider communication materials. Train billing and authorization staff on the two separate approval pathways (soft tissue sarcoma vs. liposarcoma/leiomyosarcoma). Communicate policy requirements to all oncology and hematology providers serving Indiana Medicaid patients. Failure to obtain prior authorization will result in claim denials.