MedicaidPrior AuthMedium impact
Tevimbra® (tislelizumab-jsgr) (New)
Humana·LA · Oncology, Gastroenterology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has established a new prior authorization policy for Tevimbra® (tislelizumab-jsgr), a cancer immunotherapy drug used for esophageal squamous cell carcinoma and gastric/gastroesophageal junction adenocarcinoma. The policy requires specific diagnostic and treatment criteria to be met before approval, with 6-month approval periods.
Action Required
Before June 1, 2026: Billing team must implement prior authorization requirements for Tevimbra® (tislelizumab-jsgr) for Louisiana Medicaid patients. Update billing system to flag oncology cases requiring this drug and ensure providers document: unresectable/metastatic diagnosis, tumor biomarker status (PD-L1 CPS scores, HER2 status), prior treatment history, and planned combination therapy protocols. Create workflow to submit prior auth requests with required clinical criteria. Claims will be denied without proper authorization.