Medicare AdvantageCoverageLow impact
Tecelra (afamitresgene autoleucel) - Medicare Advantage (Revised)
Humana·Oncology, Transplant Surgery·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
New Medicare Advantage coverage policy for Tecelra (afamitresgene autoleucel), a specialized T-cell gene therapy for metastatic synovial sarcoma. Coverage requires specific genetic markers, prior chemotherapy, and Corporate Transplant Department approval with strict eligibility criteria including one lifetime dose limit.
Action Required
Before May 1, 2026: Billing team must route all Tecelra (afamitresgene autoleucel) requests to Corporate Transplant Department at 1-866-421-5663 or transplant@humana.com for prior authorization. Update billing system to flag HCPCS Q2057 for mandatory transplant department review. Verify patient meets all eligibility criteria including HLA genetic testing and MAGE-A4 tumor expression before submitting claims.