MedicaidPrior AuthMedium impact
Adcetris® (brentuximab vedotin) (New)
Humana·IN · Oncology·Medicaid
We identified it
Jul 1, 2026
Summary
Humana Medicaid Indiana has implemented a new Prior Authorization policy for Adcetris® (brentuximab vedotin), an oncology therapeutic. This policy requires prior authorization approval before claims can be processed for Indiana Medicaid members. The billing team must establish new workflow procedures to request and obtain authorization before administering or billing for this drug.
Action Required
Immediately: Billing team and clinical staff must implement prior authorization requirements for all Adcetris® (brentuximab vedotin) claims for Humana Medicaid Indiana members. (1) Access the Humana policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5fb to review specific approval criteria, documentation requirements, and contact procedures. (2) Update billing system and EMR to flag all Adcetris® prescriptions/orders as requiring prior auth before submission. (3) Create a checklist for providers documenting diagnosis, clinical justification, and patient medical history required for authorization requests. (4) Train front desk, clinical, and billing staff on the new authorization workflow and submission process. (5) Establish a tracking system to monitor authorization status and follow up with Humana if approvals are not received within standard timeframes. Failure to obtain prior authorization will result in claim denials and delayed reimbursement.