Medicare AdvantagePrior AuthMedium impact
Istodax (romidepsin) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Istodax (romidepsin) prior authorization policy effective January 28, 2026 for Medicare and Medicaid (Florida, Kentucky, South Carolina). The policy requires prior authorization for romidepsin use in cutaneous T-cell lymphoma (CTCL), with approval contingent on the drug being used as primary biologic systemic therapy OR the member having received at least one prior therapy. Members with disease progression on romidepsin are excluded from coverage.
Action Required
By January 28, 2026: Billing team must implement prior authorization requirements for all Istodax (romidepsin) intravenous administrations in the affected Humana plans (Medicare and Medicaid in FL, KY, SC). Update billing system to enforce the two approval criteria: (1) use for CTCL treatment, and (2) either primary biologic systemic therapy use OR at least one prior systemic therapy documented. Add requirement to deny or flag claims for members with documented disease progression on romidepsin. Providers must obtain prior authorization before infusion administration and include treatment history documentation with PA requests. Coordinate with oncology and hematology providers to ensure compliance. Claims processed without prior authorization or missing required clinical criteria will be denied by Humana.