MedicaidPrior AuthMedium impact
Epkinly™ (epcoritamab-bysp) (Revised)
Humana·OH · Hematology, Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Epkinly (epcoritamab-bysp) for Ohio Medicaid patients with specific types of lymphoma. Requires prior auth with strict criteria including prior treatment history and excludes patients with CNS involvement or previous disease progression on similar therapies.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Epkinly (epcoritamab-bysp) for Ohio Medicaid patients. Verify patient diagnosis (DLBCL, high-grade B-cell lymphoma, or follicular lymphoma), confirm prior treatment history (2+ lines for monotherapy, 1+ for combination), and ensure no CNS involvement or prior progression on CD20-directed therapy. Claims will be denied without proper prior authorization.