High impact
Pembrolizumab products (Keytruda, Keytruda Qlex)
Humana·Effective Jul 1, 2026
Humana Indiana Medicaid has released a comprehensive prior authorization policy (effective 7/1/2026) for Pembrolizumab products (Keytruda IV/solution and Keytruda Qlex subcutaneous) covering 25+ cancer indications. The policy establishes specific clinical criteria for approval, including disease stage/progression status, biomarker requirements (PD-L1, MSI-H, dMMR), treatment combinations, and explicitly excludes patients with prior anti-PD-1/PD-L1 therapy progression. Billing teams must implement prior auth requirements before claims are submitted.