MedicaidPrior AuthMedium impact
Carvykti™ (ciltacabtagene autoleucel) (Revised)
Humana·OH · Hematology, Oncology·Medicaid
Effective date
Nov 26, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Carvykti (ciltacabtagene autoleucel), a CAR-T cell therapy for multiple myeloma patients. The policy requires specific criteria including previous treatment failures and excludes patients with certain conditions, with a maximum of one lifetime dose.
Action Required
By November 26, 2025: Billing team must implement prior authorization requirements for Carvykti (ciltacabtagene autoleucel) for Medicaid Ohio patients. Verify patients meet all 5 criteria including multiple myeloma diagnosis, relapsed/refractory disease, prior systemic therapies, age ≥18, and lymphodepleting chemotherapy use. Check for 3 exclusions (hepatitis B/C, prior transplant, prior CAR-T therapy). Contact Corporate Transplant Department at 1-866-421-5663 for all requests. Claims will be denied without proper prior authorization.