MedicaidPrior AuthLow impact
Kimmtrak (tebentafusp-tebn) (New)
Humana·OH · Oncology, Ophthalmology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Kimmtrak (tebentafusp-tebn) for Ohio Medicaid patients with metastatic uveal melanoma. Requires documentation of unresectable/metastatic uveal melanoma, HLA-A*02:01-positive disease, and use as monotherapy.
Action Required
By October 22, 2025: Billing team must update prior authorization requirements for Kimmtrak (tebentafusp-tebn) for Ohio Medicaid patients. Ensure providers document: 1) unresectable or metastatic uveal melanoma diagnosis, 2) HLA-A*02:01-positive disease assay results, 3) monotherapy use. Visit www.humana.com/PAL for specific medical billing codes. Claims without prior auth will be denied.