MedicaidPrior AuthLow impact
Imlygic (talimogene laherparepvec) (Revised)
Humana·OH · Oncology, Dermatology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Ohio Medicaid has revised their prior authorization policy for Imlygic (talimogene laherparepvec), an oncolytic viral therapy for unresectable melanoma. The policy establishes specific criteria for approval including melanoma stage requirements, age restrictions, and exclusions for immunocompromised patients and concomitant anti-PD-1/PD-L1 therapy.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Imlygic (talimogene laherparepvec) requests for Ohio Medicaid patients. Verify patients meet all three criteria: appropriate melanoma diagnosis (unresectable Stage III with in-transit metastases, local/satellite recurrence, or distant metastatic disease), age 18 or older, and intralesional therapy indication. Document exclusions including immunocompromised status, pregnancy, disease progression on Imlygic, or concomitant anti-PD-1/PD-L1 therapy. Initial approvals are for 6 months.