MedicaidPrior AuthMedium impact
Padcev (enfortumab vedotin-ejfv) (New)
Humana·LA · Oncology, Hematology·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has implemented a new Prior Authorization policy for Padcev (enfortumab vedotin-ejfv) for Louisiana Medicaid members. This is a drug-specific prior authorization requirement that billing teams must implement immediately to prevent claim denials.
Action Required
Immediately: Billing team must update the EHR/billing system to flag all claims for Padcev (HCPCS J9173) for Louisiana Medicaid members as requiring prior authorization before submission. Coordinate with clinical staff to obtain prior authorization from Humana Louisiana Medicaid before administering treatment. Update internal checklists and encounter templates to remind providers and front desk staff of this requirement. Add Padcev to the prior authorization requirements list for all oncology/hematology providers. Failure to obtain prior authorization will result in claim denials and potential patient liability.