Medicare AdvantagePrior AuthMedium impact
Tevimbra® (tislelizumab-jsgr) (Revised)
Humana·KY, SC · Oncology, Gastroenterology·Medicaid
Effective date
Nov 27, 2024
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Tevimbra (tislelizumab-jsgr), an IV cancer immunotherapy drug, effective immediately for specific esophageal and gastric cancers. Requires 6-month approval periods with specific diagnostic and treatment criteria including PD-L1 expression levels and HER2 status.
Action Required
Immediately: Billing and clinical teams must implement prior authorization requirements for Tevimbra (tislelizumab-jsgr) IV infusions. Providers must document specific criteria including: unresectable/metastatic status, PD-L1 expression levels (CPS ≥ 1), HER2 status for gastric cancers, and combination therapy details. Submit authorization requests through www.humana.com/PAL for 6-month approval periods. Claims will be denied without proper prior authorization.