MedicaidPrior AuthMedium impact
Tecvayli (teclistamab-cqyv) (New)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Tecvayli (teclistamab-cqyv), a specialized cancer treatment for multiple myeloma patients. This drug requires prior auth and has strict eligibility criteria including at least four prior lines of therapy and is only available through a restricted REMS program.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirements for Tecvayli (teclistamab-cqyv) subcutaneous solution for Louisiana Medicaid members. Update billing system to flag this drug for prior auth and ensure providers document required criteria: multiple myeloma diagnosis, relapsed/refractory disease, at least four prior therapy lines including anti-CD38 monoclonal antibody, proteasome inhibitor, and immunomodulatory agent. Claims will be denied without proper prior authorization.