MedicaidPrior AuthMedium impact
Unloxcyt™ (cosibelimab-ipdl) (New)
Humana·OH · Oncology, Dermatology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid (Ohio) has established a new prior authorization policy for Unloxcyt (cosibelimab-ipdl), a PD-L1 inhibitor for locally advanced or metastatic cutaneous squamous cell carcinoma. Approval requires patients to be ineligible for curative surgery/radiation and to receive monotherapy without prior PD-1/PD-L1 inhibitor progression. Initial authorization is for 6 months. This is a brand-new coverage policy effective May 1, 2026.
Action Required
By May 1, 2026: Billing and prior authorization teams must implement new workflow for Unloxcyt (cosibelimab-ipdl) requests in the Humana Medicaid Ohio system. Create prior authorization checklist requiring documentation of: (1) cutaneous squamous cell carcinoma diagnosis, (2) locally advanced or metastatic disease status, (3) medical record evidence patient is not a candidate for curative surgery or radiation, and (4) confirmation this is monotherapy (no concurrent PD-1/PD-L1 inhibitors). Screen all requests for Exclusion #1 (prior PD-1/PD-L1 progression). Set initial authorization duration to 6 months in system. Route denials for disease progression on prior PD-1/PD-L1 inhibitors to medical director review. Update provider communication materials and claim submission instructions. Ensure clinical review resources include NCCN Guidelines and iRECIST criteria for response assessment. Claims submitted without prior authorization or meeting exclusion criteria will be denied.