MedicaidPrior AuthMedium impact
Jevtana® (cabazitaxel) (Revised)
Humana·OH · Oncology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jul 21, 2026
Summary
This is a revised Humana Medicaid (Ohio) prior authorization policy for Jevtana® (cabazitaxel) effective September 1, 2025, most recently updated July 22, 2026. The policy requires prior authorization for Jevtana use in hormone-refractory metastatic prostate cancer patients who have previously received docetaxel and are concurrently taking corticosteroids. Billing teams must verify three mandatory criteria and screen for three exclusions (neutrophil count ≤1,500/mm³, hepatic impairment with bilirubin >3x ULN, and concomitant use with abiraterone or enzalutamide) before submitting claims.
Action Required
By September 1, 2025, the billing team must implement prior authorization requirements for Jevtana® (cabazitaxel) HCPCS code J9043 in the billing system for all Ohio Medicaid claims. Before submitting any Jevtana authorization request: (1) Verify member has diagnosis of hormone-refractory metastatic prostate cancer; (2) Confirm prior docetaxel treatment; (3) Confirm concurrent corticosteroid use (dexamethasone or prednisone); (4) Screen for exclusions—obtain recent neutrophil count (must be >1,500/mm³), hepatic function tests (total bilirubin must be ≤3x ULN), and verify no concurrent abiraterone acetate, Yonsa, or Xtandi. Update preauthorization forms and EMR templates to capture these clinical criteria. Route all J9043 claims through the prior authorization workflow before processing. Claims submitted without prior authorization or missing required clinical documentation will be denied. Notify all oncology providers of this requirement and the clinical screening checklist.