MedicaidPrior AuthMedium impact
Padcev (enfortumab vedotin-ejfv) (New)
Humana·OH · Oncology·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has issued a new Prior Authorization policy for Padcev (enfortumab vedotin-ejfv), a cancer treatment medication, effective for Medicaid members in Ohio. This is a 1-day-old policy requiring immediate attention to implement prior authorization requirements in billing workflows.
Action Required
Immediately: Billing team must implement prior authorization requirements for Padcev (enfortumab vedotin-ejfv) claims for all Ohio Medicaid members. Access the complete policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a60c to obtain specific authorization codes, medical necessity criteria, and submission requirements. Update billing software to flag Padcev prescriptions for prior authorization review before claim submission. Notify oncology providers and nursing staff of the new requirement. Failure to obtain prior authorization will result in claim denials. Contact Humana if specific billing codes or authorization procedures are not available in the summary document.