Medicare AdvantagePrior AuthMedium impact
Ixempra® (ixabepilone) (Revised)
Humana·FL, KY, SC · Oncology·Medicaid
Effective date
Jan 1, 2017
We identified it
Jun 25, 2026
Summary
This is a revised Humana prior authorization policy for Ixempra (ixabepilone) effective January 1, 2017, with a revision date of September 24, 2025. The policy clarifies coverage criteria for locally advanced or metastatic breast cancer treatment, emphasizes that NCCN no longer supports combination therapy with Xeloda (capecitabine), and includes critical contraindications for hepatic impairment, hypersensitivity reactions, and low blood counts. Prior authorization is required for all Ixempra use across Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina).
Action Required
By September 24, 2025, billing and clinical teams must implement the following: (1) Billing team: Update prior authorization workflows to reflect that combination Ixempra + Xeloda therapy is no longer guideline-supported; flag any incoming requests for this combination for clinical review before submission. (2) All staff requesting Ixempra: Ensure prior authorization includes verification of treatment failure/resistance to anthracyclines AND taxanes AND capecitabine (for monotherapy) OR anthracyclines AND taxanes (for combination therapy). (3) Clinical reviewers: Apply the stated exclusions—reject requests if member has CTC grade 3/4 hypersensitivity to Cremophor EL derivatives, AST/ALT >2.5x ULN or bilirubin >1x ULN (if combination therapy planned), ANC <1500 cells/mm3, platelets <100,000 cells/mm3, or disease progression post-treatment. (4) Providers: Document baseline hepatic and hematologic labs before Ixempra initiation, particularly if combination with capecitabine is considered. (5) All staff: Discontinue any approved authorizations for Ixempra + Xeloda combinations per NCCN guidance change; contact affected members' providers to transition to monotherapy or alternative regimens. Failure to implement prior authorization requirements will result in claim denials for this drug across affected Medicaid programs and Medicare plans.