MedicaidPrior AuthHigh impact
Adcetris® (brentuximab vedotin)
Humana·IN · Oncology, Hematology·Medicaid
Effective date
Jul 1, 2026
We identified it
Aug 11, 2026
Summary
Humana Indiana Medicaid has issued a new prior authorization policy for Adcetris (brentuximab vedotin) effective July 1, 2026, covering seven distinct indications including Hodgkin lymphoma, large B-cell lymphoma, and peripheral T-cell lymphomas. The policy establishes specific clinical criteria that must be met for approval, with initial and renewal authorization periods of 6 months. All claims for Adcetris must now go through prior authorization review before dispensing.
Action Required
By July 1, 2026: Billing team must implement prior authorization requirement for Adcetris (brentuximab vedotin, HCPCS J9041) for all Indiana Medicaid members. Update billing software to flag all J9041 claims as requiring prior auth before submission. Pharmacy staff must obtain authorization documenting that the member meets ALL applicable criteria for their specific indication (Hodgkin lymphoma previously untreated/relapsed/consolidation, LBCL, sALCL/PTCL previously untreated/relapsed, or pcALCL/MF). Verify that member does NOT have documented disease progression on Adcetris (exclusion criterion for most indications). Claims submitted without prior authorization will be denied. Oncology practices and infusion centers administering Adcetris must coordinate with prior auth team before scheduling treatment.