J7888 Insurance Policy Changes

Kymriah™ (tisagenlecleucel) (Revised)

Humana Kentucky Medicaid updated its Kymriah (tisagenlecleucel) prior authorization policy effective May 1, 2026, clarifying coverage criteria for three indications: diffuse large B-cell lymphoma (DLBCL), acute lymphoblastic leukemia (ALL), and follicular lymphoma. The policy maintains strict eligibility requirements including prior therapy lines, disease status, age limits, and multiple exclusions (prior gene therapy, prior anti-CD19 therapy, active hepatitis B/C, HIV/AIDS, and for lymphoma patients, prior allogeneic transplant). All approvals are limited to one dose per lifetime with 60-day authorization duration.