MedicaidPrior AuthMedium impact
Emrelis (telisotuzumab vedotin-tllv) (Revised)
Humana·OH · Oncology, Pulmonology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Emrelis (telisotuzumab vedotin-tllv), a specialized cancer treatment for non-small cell lung cancer. The policy requires specific diagnostic criteria including c-Met protein overexpression testing and prior systemic therapy documentation before approval.
Action Required
By September 1, 2025: Billing team must implement prior authorization requirements for Emrelis (telisotuzumab vedotin-tllv) for Ohio Medicaid patients. Providers must document: 1) locally advanced/metastatic non-squamous EGFR wild-type NSCLC diagnosis, 2) c-Met protein overexpression ≥50% with IHC 3+ staining via FDA-approved test, 3) previous systemic therapy history, and 4) monotherapy usage. Update EMR templates to capture required criteria and alert staff that claims will be denied without proper prior authorization.