MedicaidPrior AuthMedium impact
Tivdak (tisotumab vedotin-tftv) (New)
Humana·OH · Oncology·Medicaid
Effective date
Oct 1, 2025
We identified it
Sep 2, 2026
Summary
Humana Medicaid (Ohio) has issued a new prior authorization policy for Tivdak (tisotumab vedotin-tftv), a cancer treatment for recurrent/metastatic cervical cancer. The policy requires prior auth for this intravenous monotherapy when used as subsequent treatment after chemotherapy failure, with specific clinical criteria including CPS score assessment and documented medical reason for not using Keytruda. Billing teams must implement prior authorization requirements before claims submission.
Action Required
Before October 1, 2025: Billing team and prior authorization staff must implement prior authorization requirements for Tivdak (tisotumab vedotin-tftv) claims under Humana Medicaid Ohio. Specific actions: (1) Update billing system to flag all Tivdak intravenous solution claims for mandatory prior auth; (2) Create prior auth request templates requiring documentation of: recurrent/metastatic cervical cancer diagnosis, disease progression after chemotherapy, CPS score status, and medical reason if Keytruda cannot be used; (3) Brief clinical review staff on approval criteria and exclusions (treatment will be denied if disease progression occurs on Tivdak); (4) Notify oncology providers of new prior auth requirement and required supporting documentation. Refer providers to www.humana.com/PAL for claim coding information. Failure to obtain prior authorization will result in claim denials from Humana.