MedicaidPrior AuthMedium impact
Istodax (romidepsin) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 28, 2026
We identified it
Aug 12, 2026
Summary
Humana has revised its prior authorization policy for Istodax (romidepsin) effective January 28, 2026 for Medicaid members in Florida, Kentucky, and South Carolina. The policy maintains coverage for cutaneous T-cell lymphoma (CTCL) treatment when used as primary biologic systemic therapy OR after at least one prior therapy, with an explicit exclusion for members experiencing disease progression on romidepsin. Billing teams must verify prior authorization is obtained before claim submission for these Medicaid populations.
Action Required
By January 28, 2026: Billing team must update prior authorization requirements in billing system for all Istodax (romidepsin) claims submitted for Medicaid members in Florida, Kentucky, and South Carolina. Verify that prior auth requests include: (1) confirmation that treatment is for CTCL, (2) documentation that member is receiving romidepsin as primary biologic systemic therapy OR has received at least one prior therapy, and (3) confirmation member does NOT have documented disease progression while on romidepsin. Update PA submission templates to screen for the disease progression exclusion criterion. Train billing and clinical staff to flag claims that do not meet approval criteria, as these will be denied. Update internal workflows to route all romidepsin PA requests through clinical review. No specific billing codes are listed in this policy; refer to Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for applicable medical and procedural coding information.