MedicaidPrior AuthMedium impact
Kymriah™ (tisagenlecleucel) (Revised)
Humana·SC · Hematology, Oncology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana revised their Medicaid prior authorization policy for Kymriah (tisagenlecleucel), a specialized CAR-T cell therapy for certain blood cancers including B-cell lymphomas and acute lymphoblastic leukemia. The policy now covers three specific indications with detailed criteria for approval, requiring coordination with Humana's Corporate Transplant Department for all requests.
Action Required
Immediately: For any Kymriah (tisagenlecleucel) requests, billing team must contact Humana's Corporate Transplant Department at 1-866-421-5663 or transplant@humana.com before submission. Ensure all prior authorization criteria are met including age requirements, diagnosis confirmation, and treatment history documentation. Maximum one dose per lifetime applies with 60-day approval duration.