MedicaidPrior AuthLow impact
Imlygic (talimogene laherparepvec) (Revised)
Humana·LA · Oncology, Dermatology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana 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 or pregnant patients.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for Imlygic (talimogene laherparepvec) for Louisiana Medicaid patients. Verify patients meet all three criteria: appropriate melanoma diagnosis (unresectable Stage III with in-transit metastases, unresectable local/satellite recurrence, or unresectable/distant metastatic disease), age 18 or older, and intralesional therapy indication. Confirm no exclusions apply (immunocompromised status, pregnancy, disease progression on Imlygic, or concomitant anti-PD-1/PD-L1 therapy). Claims without proper prior authorization will be denied.