MedicaidPrior AuthMedium impact
Adcetris® (brentuximab vedotin) (New)
Humana·OH · Oncology, Hematology·Medicaid
We identified it
Jul 1, 2026
Summary
Humana has implemented a new Prior Authorization policy for Adcetris® (brentuximab vedotin), a chemotherapy agent used primarily in hematologic malignancies. This policy applies to Ohio Medicaid members and requires prior authorization before claims will be processed. The billing team must identify all Adcetris® administrations and obtain approval before service delivery to prevent claim denials.
Action Required
Immediately: Billing team and providers must identify all Adcetris® (brentuximab vedotin) claims for Ohio Medicaid members and implement prior authorization workflow before claim submission. Contact Humana at the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5f9) to access full policy details including specific authorization procedures, documentation requirements, and clinical criteria. Update billing system rules to flag Adcetris® claims for Ohio Medicaid as requiring prior auth. Obtain and document prior authorization approval number before billing. Claims submitted without prior authorization approval will be denied. Front desk and clinical staff should flag this medication at scheduling/treatment planning stage.