MedicaidPrior AuthMedium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Epkinly (epcoritamab-bysp) for Louisiana Medicaid patients with diffuse large B-cell lymphoma and follicular lymphoma. Requires specific criteria including prior lines of therapy and excludes patients with CNS involvement or disease progression on similar treatments.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Epkinly (epcoritamab-bysp) for Louisiana Medicaid patients. Verify patients meet criteria including 2+ prior systemic therapy lines for DLBCL/HGBL or appropriate criteria for follicular lymphoma. Check for exclusions including CNS involvement. Visit www.humana.com/PAL for medical billing codes. Claims without proper prior authorization will be denied.