Medicare AdvantagePrior AuthMedium impact
Tivdak (tisotumab vedotin-tftv) (Revised)
Humana·FL, KY, SC · Oncology·Medicaid
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Tivdak (tisotumab vedotin-tftv) prior authorization policy effective August 27, 2025. The policy now applies to Medicare, Florida Medicaid, Kentucky Medicaid, and South Carolina Medicaid for recurrent/metastatic cervical cancer treatment. Key change: Florida Medicaid requests are now exempt from the step therapy requirement (Keytruda trial), while Medicare and other state Medicaid plans still require documented medical reason for not using pembrolizumab first.
Action Required
By August 27, 2025: Billing and prior authorization teams must update Tivdak approval logic in their authorization systems to reflect state-specific step therapy rules. Specifically: (1) Remove step therapy requirement for all Florida Medicaid Tivdak requests; (2) Maintain step therapy requirement (Keytruda trial documented) for Medicare and Kentucky/South Carolina Medicaid requests; (3) Update approval templates and clinical review checklists to note the Florida Medicaid exemption; (4) Train staff reviewing Tivdak prior auths to verify member state and plan type before applying step therapy criteria. Failure to apply correct state rules will result in improper denials (Florida) or approvals without required documentation (Medicare/other Medicaid).