MedicaidPrior AuthMedium impact
Istodax (romidepsin)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Mar 1, 2026
We identified it
Aug 12, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Istodax (romidepsin) effective March 1, 2026. The policy requires prior authorization for all romidepsin IV infusions used to treat cutaneous T-cell lymphoma, with coverage limited to patients receiving it as primary biologic systemic therapy or those with at least one prior therapy. Patients with disease progression on romidepsin are excluded from coverage.
Action Required
By February 1, 2026: Billing and clinical teams must implement prior authorization requirements for all Istodax/romidepsin IV infusion claims for Ohio Medicaid members. (1) Update billing system to flag romidepsin IV orders for prior auth before claim submission. (2) Providers must document that patients meet coverage criteria: romidepsin used as primary biologic systemic therapy OR patient has received at least one prior therapy for CTCL. (3) Front desk/authorization staff must screen for exclusions: disease progression history while on romidepsin, uncorrected potassium/magnesium deficiency, pregnancy/breastfeeding status, and age under 18 years. (4) Clinical staff must verify baseline electrolyte corrections before approving requests. (5) Update encounter templates to capture prior CTCL therapy history and current disease status. Claims submitted without prior authorization or missing required documentation will be denied. Approvals valid for plan year duration or determined through clinical review.