MedicaidPrior AuthMedium impact
Carvykti™ (ciltacabtagene autoleucel) (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established a new prior authorization policy for Carvykti (ciltacabtagene autoleucel), a CAR-T cell therapy for multiple myeloma. The policy requires strict criteria verification and has a one-dose-per-lifetime limit with 60-day approval periods.
Action Required
Immediately: For South Carolina Medicaid patients needing Carvykti CAR-T therapy, billing team must verify all 5 criteria are met (multiple myeloma diagnosis, relapsed/refractory disease per IMWG criteria, prior therapy with immunomodulatory agent + proteasome inhibitor + anti-CD38 antibody, age 18+, lymphodepleting chemotherapy planned) and check for 3 exclusions (active hepatitis B/C, prior allogeneic transplant, prior CAR-T therapy). Refer all requests to Corporate Transplant Department at 1-866-421-5663. Note one-dose-per-lifetime limit in patient records.