MedicaidPrior AuthMedium impact
Jevtana® (cabazitaxel) (Revised)
Humana·IN · Oncology, Urology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jul 21, 2026
Summary
This is a revised Humana Medicaid (Indiana) prior authorization policy for Jevtana® (cabazitaxel) for hormone-refractory metastatic prostate cancer. The policy requires prior authorization and specifies three mandatory approval criteria: hormone-refractory metastatic prostate cancer diagnosis, prior docetaxel treatment, and concurrent corticosteroid use. Three exclusions apply: neutrophil counts ≤1,500/mm³, severe hepatic impairment (bilirubin >3x ULN), and concomitant use with abiraterone acetate, Yonsa, or Xtandi.
Action Required
Before September 1, 2025: Billing team must implement prior authorization requirement in billing system for Jevtana (J9017) for all Indiana Medicaid claims. Update claim submission workflow to include mandatory documentation of: (1) diagnosis of hormone-refractory metastatic prostate cancer, (2) prior docetaxel treatment history, and (3) concurrent corticosteroid therapy (dexamethasone or prednisone). Add clinical review checklist to verify patient does not have: neutrophils ≤1,500/mm³, total bilirubin >3x ULN, or concomitant abiraterone acetate/Yonsa/Xtandi use. Providers must submit prior authorization requests with required clinical documentation before dispensing. Claims submitted without prior authorization approval will be denied. Update encounter templates and billing system rules accordingly.