Medicare AdvantagePrior AuthMedium impact
Emrelis (telisotuzumab vedotin-tllv) (Revised)
Humana·KY, SC · Oncology, Pulmonology·Medicaid
Effective date
Jul 23, 2025
We identified it
Jun 24, 2026
Summary
Humana has established new prior authorization requirements for Emrelis (telisotuzumab vedotin-tllv), a cancer treatment for non-small cell lung cancer patients. The policy requires specific diagnostic criteria including c-Met protein overexpression testing and previous systemic therapy before approval.
Action Required
By July 23, 2025: Billing team must implement prior authorization requirements for Emrelis (telisotuzumab vedotin-tllv) infusions for Medicare and Medicaid patients in Kentucky and South Carolina. Providers must document: 1) locally advanced or metastatic non-squamous, EGFR wild-type NSCLC diagnosis, 2) high c-Met protein overexpression (≥50% tumor cells with 3+ staining) via FDA-approved test, 3) previous systemic therapy history, and 4) monotherapy treatment plan. Claims will be denied without proper prior authorization.