Padcev (enfortumab vedotin-ejfv) (New)

By June 15, 2026: Billing and clinical teams must implement prior authorization requirements for all Padcev (enfortumab vedotin-ejfv) claims for Humana Medicaid Ohio members. Specifically: (1) Update billing system to flag all Padcev claims for mandatory prior auth before submission; (2) Create internal checklist requiring verification of patient eligibility criteria before PA request submission—confirm diagnosis (locally advanced/metastatic urothelial cancer OR muscle-invasive bladder cancer), prior treatment history (platinum chemotherapy, PD-1/PD-L1 inhibitor status, or cisplatin ineligibility documentation including CrCl, performance status, hearing/neuropathy/cardiac function); (3) Providers must document all required clinical criteria in patient chart before prescribing; (4) Front desk/authorization staff should verify member plan type before processing claims; (5) Update encounter forms and templates to capture treatment history and cisplatin eligibility status. Failure to obtain prior authorization will result in claim denials. Note the black box warning regarding severe skin reactions (SJS/TEN)—ensure providers and patients receive risk notification materials.