MedicaidPrior AuthMedium impact
Carvykti™ (ciltacabtagene autoleucel) (Revised)
Humana·LA · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicaid (Louisiana) prior authorization policy for Carvykti (ciltacabtagene autoleucel), a CAR-T cell therapy for relapsed or refractory multiple myeloma. The policy requires patients to meet five clinical criteria (diagnosis, relapsed/refractory disease, prior multi-line therapy, age ≥18, use with lymphodepleting chemotherapy) and excludes those with active hepatitis B/C, prior allogeneic transplant, or prior CAR-T therapy. Approval is limited to one lifetime dose with a 60-day authorization duration.
Action Required
Before submitting any Carvykti claims to Humana Louisiana Medicaid: (1) Billing and clinical teams must verify all five approval criteria are met and documented: diagnosis of multiple myeloma, relapsed/refractory disease per IMWG criteria, at least one prior line of therapy including immunomodulatory agent, proteasome inhibitor, and anti-CD38 monoclonal antibody, patient age ≥18, and planned use with lymphodepleting chemotherapy. (2) Verify patient does not have any exclusions: active hepatitis B, active hepatitis C, prior allogeneic transplant, or prior CAR-T therapy. (3) Submit all prior authorization requests to Humana Corporate Transplant Department at 1-866-421-5663, Fax: 502-508-9300, or Email: transplant@humana.com—do not submit through standard prior auth channels. (4) Ensure authorization duration is set to 60 days and document that this is a maximum one lifetime dose. (5) Include all supporting clinical documentation demonstrating patient meets all criteria. Failure to obtain proper prior authorization will result in claim denial.