Medicare AdvantagePrior AuthMedium impact
Jevtana® (cabazitaxel) (Revised)
Humana·FL, KY, SC, VA · Oncology, Urology·Medicaid
Effective date
Jul 23, 2025
We identified it
Jun 25, 2026
Summary
This is a revised Jevtana (cabazitaxel) prior authorization policy effective January 1, 2020, with the most recent revision dated July 23, 2025. The policy covers Jevtana for hormone-refractory metastatic prostate cancer in Medicare and four Medicaid state plans (Florida, Kentucky, South Carolina, Virginia). Billing teams must verify prior authorization requirements are met before claim submission, including confirmation of prior docetaxel treatment, concurrent corticosteroid use, and absence of contraindications (low neutrophil counts, severe hepatic impairment, or concomitant use with abiraterone acetate or enzalutamide).
Action Required
By August 6, 2025: Billing and clinical teams must update prior authorization workflows to ensure compliance with the revised July 23, 2025 policy. Specific actions: (1) Verify all Jevtana claims require prior authorization through Humana; (2) Prior to claim submission, confirm the member meets all three approval criteria: diagnosis of hormone-refractory metastatic prostate cancer, prior docetaxel treatment history, and concurrent corticosteroid use (dexamethasone or prednisone); (3) Screen for three key exclusions: neutrophil count ≤1,500/mm3 (obtain recent CBC), total bilirubin >3x ULN indicating severe hepatic impairment, and concomitant use of abiraterone acetate, Yonsa, or Xtandi; (4) Update claim submission templates and EMR flags to require documentation of these criteria and exclusion screening; (5) Train billing staff to deny or hold claims that lack required clinical documentation. Assign this to: Billing team (workflow updates), Clinical reviewers (documentation verification), and EMR/IT staff (system configuration). Failure to obtain proper prior authorization or submit claims missing required clinical justification will result in claim denials for Medicaid and Medicare Advantage beneficiaries in FL, KY, SC, and VA.