MedicaidPrior AuthMedium impact
Tevimbra® (tislelizumab-jsgr) (New)
Humana·OH · Oncology, Gastroenterology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Tevimbra® (tislelizumab-jsgr), a cancer immunotherapy drug for esophageal and gastric cancers. This policy requires prior authorization with specific clinical criteria including tumor biomarker testing and combination therapy requirements.
Action Required
By June 1, 2026: Billing team must implement prior authorization requirements for Tevimbra® (tislelizumab-jsgr) for Ohio Medicaid patients. Update billing system to flag claims requiring documentation of unresectable/metastatic esophageal squamous cell carcinoma or gastric adenocarcinoma, PD-L1 testing results (CPS ≥1), HER2 status for gastric cancers, and combination therapy protocols. Ensure providers document all clinical criteria before prescribing. Claims without proper prior authorization will be denied.