MedicaidPrior AuthMedium impact
Breyanzi® (lisocabtagene maraleucel) (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established comprehensive prior authorization requirements for Breyanzi (lisocabtagene maraleucel), a CAR-T cell therapy for various lymphomas and leukemias. The policy covers six different cancer indications with specific eligibility criteria, exclusions, and a lifetime maximum of one dose per member.
Action Required
Immediately: Billing and prior authorization teams must implement prior authorization requirements for all Breyanzi (lisocabtagene maraleucel) treatments for Humana Medicaid South Carolina members. Verify patient eligibility against specific criteria for each indication (Large B-cell Lymphoma 2L/3L, CLL/SLL, Follicular Lymphoma, Mantle Cell Lymphoma, Marginal Zone Lymphoma), document exclusion criteria screening, and ensure lymphodepleting chemotherapy coordination. Update prior auth workflow to reflect 60-day approval duration and lifetime maximum of one dose.