MedicaidPrior AuthMedium impact
Padcev (enfortumab vedotin-ejfv) (New)
Humana·IN · Oncology·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has issued a new Prior Authorization policy for Padcev (enfortumab vedotin-ejfv) for Indiana Medicaid members. This is a newly added drug requiring prior authorization before claims will be processed. The billing team must implement prior auth requirements immediately to prevent claim denials.
Action Required
Immediately: Billing team must update prior authorization system to require approval for Padcev (HCPCS J9173) for all Indiana Medicaid members before claim submission. Flag all Padcev claims in billing software to require prior auth verification. Notify oncology providers and infusion centers that Padcev now requires prior authorization through Humana. Claims submitted without prior authorization documentation will be denied. Reference Humana policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a60a for specific authorization criteria and contact information.