MedicaidPrior AuthLow impact
Imlygic (talimogene laherparepvec) (Revised)
Humana·IN · Oncology, Dermatology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has established new prior authorization requirements for Imlygic (talimogene laherparepvec), an oncolytic viral therapy for unresectable melanoma. The policy requires patients to meet specific criteria including having unresectable Stage III melanoma with in-transit metastases and excludes immunocompromised patients and those on concomitant anti-PD-1/PD-L1 agents.
Action Required
Before January 1, 2026: Billing team must update prior authorization procedures for Imlygic (talimogene laherparepvec) for Indiana Medicaid patients. Providers must verify patient meets all three criteria (specific melanoma diagnosis, intralesional therapy indication, age 18+) and document absence of exclusions (immunocompromised status, pregnancy, disease progression on Imlygic, concomitant anti-PD-1/PD-L1 therapy). Update encounter forms to include melanoma staging and treatment history documentation requirements.