MedicaidPrior AuthMedium impact
Jemperli (dostarlimab-gxly)
Humana·LA · Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Aug 6, 2026
Summary
Humana Louisiana Medicaid has established a new Prior Authorization policy for Jemperli (dostarlimab-gxly), effective November 1, 2025. The policy covers three indications: frontline endometrial cancer (in combination with chemotherapy), second-line endometrial cancer (dMMR, monotherapy), and dMMR solid tumors (monotherapy). All requests require prior authorization with specific clinical criteria, and claims will be denied if patients have disease progression on prior anti-PD-1/PD-L1 therapy.
Action Required
By November 1, 2025: (1) Billing team must update billing system to flag all Jemperli claims for mandatory prior authorization before submission. (2) Create three separate authorization templates in the prior auth submission system corresponding to the three covered indications (frontline EC, 2nd line EC, and dMMR solid tumors). (3) Providers must document: diagnosis (primary advanced/recurrent endometrial cancer OR dMMR status for solid tumors), prior treatment history (including any prior anti-PD-1/PD-L1 therapy use), intended treatment regimen (combination vs. monotherapy), and disease progression status. (4) Front desk and authorization staff must verify during pre-authorization that patients do NOT have prior disease progression on anti-PD-1/PD-L1 therapy (e.g., nivolumab, pembrolizumab), as this is an automatic exclusion. (5) Set authorization duration tracking: Initial approvals = plan year duration (or clinical review determination); Renewals = plan year duration for frontline, 6 months for 2nd line and solid tumors. Failure to obtain prior authorization before billing will result in claim denials by Humana Louisiana Medicaid.