MedicaidPrior AuthHigh impact
Adcetris® (brentuximab vedotin) (New)
Humana·LA · Oncology, Hematology·Medicaid
We identified it
Jul 1, 2026
Summary
Humana has issued a new Prior Authorization policy for Adcetris® (brentuximab vedotin) effective immediately for Louisiana Medicaid members. The billing team must obtain prior authorization before administering this chemotherapy agent or claims will be denied.
Action Required
Immediately: Billing team and providers must obtain prior authorization from Humana before administering Adcetris® (brentuximab vedotin) to Louisiana Medicaid members. Update billing system to flag HCPCS code J9041 as requiring prior auth for this plan. Notify all oncology staff and infusion center personnel that this drug now requires pre-approval. Any claims submitted without prior authorization documentation will be denied, resulting in patient balance billing and delayed treatment.