MedicaidPrior AuthMedium impact
Jevtana® (cabazitaxel) (Revised)
Humana·FL, KY, SC, VA · Oncology·Medicaid
Effective date
Jan 1, 2020
We identified it
Jul 22, 2026
Summary
This is a revised Jevtana (cabazitaxel) prior authorization policy effective January 1, 2020, with the most recent revision dated July 22, 2026. The policy applies to Medicaid programs in Florida, Kentucky, South Carolina, and Virginia, requiring prior authorization for cabazitaxel use in hormone-refractory metastatic prostate cancer patients who meet specific clinical criteria including prior docetaxel treatment and concurrent corticosteroid use. Key exclusions prohibit use in patients with neutrophil counts ≤1,500/mm³, severe hepatic impairment (total bilirubin >3x ULN), or concurrent use with abiraterone acetate or enzalutamide.
Action Required
By the date of patient service: Billing and clinical teams must verify prior authorization approval before processing Jevtana (cabazitaxel) claims for Medicaid beneficiaries in FL, KY, SC, and VA. Prior to claim submission, confirm that the patient meets all three clinical criteria: (1) hormone-refractory metastatic prostate cancer diagnosis, (2) prior docetaxel treatment history, and (3) concurrent corticosteroid use. Verify absence of exclusionary conditions (neutrophils ≤1,500/mm³, total bilirubin >3x ULN, or concurrent abiraterone/enzalutamide use). Rejection of claims will occur without documented prior authorization approval. Update billing software system to flag J9043 for mandatory prior authorization review before processing for affected Medicaid plans. Train front desk staff to confirm state-specific Medicaid eligibility (FL, KY, SC, VA only) during patient check-in for oncology visits involving chemotherapy.