MedicaidPrior AuthMedium impact
Pedmark® (sodium thiosulfate injection) (Revised)
Humana·OH · Oncology, Pediatrics, Pharmacy·Medicaid
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid Ohio revised its Pedmark (sodium thiosulfate injection) coverage policy effective March 25, 2026. This is a prior authorization requirement for pediatric patients (1 month to <18 years) receiving cisplatin-based therapy for localized, non-metastatic solid tumors to reduce ototoxicity risk. The policy specifies weight-based dosing, timing requirements (6 hours after cisplatin completion, minimum 10 hours before next infusion), and a critical limitation: cisplatin infusions longer than 6 hours may negate protective benefit.
Action Required
Before March 25, 2026: (1) Billing team must configure system to require prior authorization for all Pedmark (sodium thiosulfate injection) claims for Humana Medicaid Ohio members. (2) Verify member meets all three criteria: age 1 month to <18 years, localized non-metastatic solid tumor, currently receiving cisplatin therapy. (3) Update prior auth submission templates to capture cisplatin infusion duration and confirm it does not exceed 6 hours. (4) Providers must document: patient age/weight for dosing calculation, tumor type and stage, cisplatin infusion schedule and duration, and timing of Pedmark administration (6 hours post-cisplatin). (5) Note: Pedmark is NOT substitutable with other sodium thiosulfate products—specify Pedmark brand in all authorizations. (6) Front desk/billing staff: Flag Pedmark claims for pediatric oncology cases immediately for prior auth processing before claim submission to avoid denials. Claims submitted without prior authorization will be denied by Humana Medicaid Ohio.