MedicaidPrior AuthMedium impact
Xofigo® (radium Ra 223 dichloride) (New)
Humana·OH · Oncology, Radiation Oncology, Nuclear Medicine·Medicaid
We identified it
Jul 2, 2026
Summary
Humana Ohio Medicaid has implemented a new Prior Authorization policy for Xofigo® (radium Ra 223 dichloride), a radiopharmaceutical used in oncology treatment. This policy requires billing teams to obtain prior authorization before administering or billing for this drug for Ohio Medicaid members.
Action Required
Immediately: Billing and clinical staff must implement prior authorization requirements for Xofigo® (radium Ra 223 dichloride) for all Ohio Medicaid members. Contact Humana Ohio Medicaid before scheduling or administering treatment to obtain prior authorization. Update your billing system and EMR to flag Xofigo® orders for Medicaid members as requiring prior auth review. Consult the full policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5f7 for specific clinical criteria and authorization procedures. Claims submitted without prior authorization will be denied.