MedicaidPrior AuthMedium impact
Tivdak (tisotumab vedotin-tftv) (New)
Humana·IN · Oncology, Pharmacy·Medicaid
Effective date
Oct 1, 2025
We identified it
Sep 2, 2026
Summary
Humana Indiana Medicaid has implemented a new prior authorization policy for Tivdak (tisotumab vedotin-tftv), a cancer treatment for recurrent or metastatic cervical cancer. Coverage requires disease progression after chemotherapy, a CPS score ≥1, medical contraindication to pembrolizumab, and monotherapy administration. Prior authorization is mandatory before dispensing.
Action Required
By October 1, 2025: Billing and prior authorization teams must implement Tivdak prior authorization requirements in the Humana Indiana Medicaid workflow. (1) Establish a prior authorization submission process for Tivdak claims; (2) Create a checklist requiring verification of all four approval criteria (recurrent/metastatic cervical cancer diagnosis, disease progression post-chemotherapy, CPS score ≥1 with documented medical reason against pembrolizumab, and monotherapy use); (3) Train clinical and billing staff on the four mandatory criteria and exclusion rule (disease progression on Tivdak); (4) Update claim submission templates to require prior authorization before pharmacy dispensing; (5) Configure billing system to flag Tivdak claims for prior auth review. Failure to obtain prior authorization will result in claim denials for Indiana Medicaid members. Contact Humana PAL at www.humana.com/PAL for medically billed claim coding requirements.