MedicaidPrior AuthMedium impact
Abecma® (idecabtagene vicleucel) (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Abecma (idecabtagene vicleucel), a CAR-T cell therapy for multiple myeloma, effective for South Carolina Medicaid. Requires prior auth with specific criteria including at least 2 prior therapy lines and excludes patients with hepatitis B/C, prior transplant, or prior CAR-T therapy.
Action Required
Immediately: Billing team must implement prior authorization requirements for Abecma (idecabtagene vicleucel) for South Carolina Medicaid patients. Verify patients meet all 5 criteria including multiple myeloma diagnosis, relapsed/refractory disease, at least 2 prior therapy lines, age 18+, and lymphodepleting chemotherapy use. Check for exclusions (hepatitis B/C, prior transplant, prior CAR-T). Contact Corporate Transplant Department at 1-866-421-5663 for all requests. Claims will be denied without proper prior authorization.