MedicaidPrior AuthHigh impact
Pembrolizumab products (Keytruda, Keytruda Qlex) (New)
Humana·IN · Oncology·Medicaid
We identified it
Jul 2, 2026
Summary
Humana has issued a new Prior Authorization policy for Pembrolizumab products (Keytruda, Keytruda Qlex) effective for Medicaid—Indiana members. The policy requires prior authorization before these drugs can be dispensed or administered. Billing teams must implement prior auth verification workflows to prevent claim denials.
Action Required
Immediately: Billing team and clinical staff must implement prior authorization requirements for all Pembrolizumab products (Keytruda, Keytruda Qlex) for Indiana Medicaid members. Update billing system to flag these drugs and require prior auth approval before claims submission. Contact Humana via the provided URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a606) to obtain complete policy details including specific approval criteria, required documentation, and authorization contact information. Brief all oncology providers and infusion center staff on the new requirement. Claims submitted without prior authorization will be denied.