MedicaidPrior AuthMedium impact
Jemperli (dostarlimab-gxly)
Humana·IN · Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Aug 6, 2026
Summary
Humana Indiana Medicaid implemented a new prior authorization policy for Jemperli (dostarlimab-gxly), an immunotherapy for endometrial cancer and dMMR solid tumors, effective November 1, 2025. The policy establishes three covered indications (frontline endometrial cancer with chemotherapy, second-line+ endometrial cancer, and dMMR solid tumors) with specific clinical criteria and exclusions. All uses require prior authorization with approval durations of plan year for frontline therapy and 6 months for subsequent therapies.
Action Required
By October 25, 2025: Billing and clinical staff must implement prior authorization requirement for all Jemperli claims under Humana Indiana Medicaid. (1) Update billing system to require PA submission before claims processing for Jemperli IV infusions. (2) Providers and clinical staff must verify at point of service: member has appropriate diagnosis (advanced/recurrent endometrial cancer OR dMMR solid tumors), appropriate line of therapy (frontline with carboplatin/paclitaxel OR second-line+ for endometrial OR monotherapy for dMMR tumors), documented dMMR status where required, and NO prior disease progression on anti-PD-1/PD-L1 therapy. (3) Develop PA submission template requiring documentation of diagnosis, disease stage, prior treatments, and clinical justification. (4) Front desk and billing staff must flag Jemperli requests for manual PA review—do not auto-adjudicate. (5) Communicate to providers that claims submitted without approved PA will be denied. This policy applies ONLY to Humana Indiana Medicaid; verify plan type before applying requirements.