MedicaidPrior AuthMedium impact
Tevimbra® (tislelizumab-jsgr) (New)
Humana·IN · Oncology, Gastroenterology·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana 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) in billing system for Indiana Medicaid patients. Update encounter forms to remind oncology providers of diagnostic criteria requirements including tumor biomarker testing (PD-L1 CPS ≥ 1, HER2-negative status). Ensure medical necessity documentation includes unresectable/metastatic disease status and prior treatment history. Claims will require prior authorization approval before processing.