MedicaidPrior AuthLow impact
Tecartus™ (brexucabtagene autoleucel) (Revised)
Humana·SC · Oncology, Hematology·Medicaid
Effective date
Jul 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has revised their prior authorization policy for Tecartus (brexucabtagene autoleucel), a specialized CAR-T cell therapy for mantle cell lymphoma and acute lymphoblastic leukemia. The policy establishes strict criteria including age requirements (≥18 years), specific disease stages, and multiple exclusions including prior CAR-T therapy and certain infections.
Action Required
Immediately: Billing team must ensure all Tecartus (brexucabtagene autoleucel) requests for Medicaid South Carolina members are routed to Humana's Corporate Transplant Department at 1-866-421-5663 or transplant@humana.com before billing. Verify patient meets all criteria (age ≥18, specific diagnoses, no prior CAR-T therapy) and obtain prior authorization. Claims will be denied without proper prior authorization.