MedicaidPrior AuthMedium impact
Tecartus™ (brexucabtagene autoleucel) (Revised)
Humana·LA · Oncology, Hematology, Pharmacy·Medicaid
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
This is a revised Tecartus (brexucabtagene autoleucel) prior authorization policy for Medicaid-Louisiana effective January 1, 2023, with the most recent revision dated May 1, 2026. The policy covers CAR-T cell therapy for relapsed/refractory mantle cell lymphoma and acute lymphoblastic leukemia in adults ≥18 years, requiring prior authorization with specific clinical criteria and exclusions. One lifetime dose maximum applies with 60-day approval duration per treatment.
Action Required
By May 1, 2026: Billing and prior authorization teams must ensure all Tecartus requests for Louisiana Medicaid members follow the revised criteria: (1) Verify member has confirmed diagnosis of relapsed/refractory mantle cell lymphoma OR B-cell precursor ALL with CD19 expression; (2) Confirm member is ≥18 years old; (3) Screen for all exclusions including prior CD19-directed CAR-T therapy, active hepatitis B/C, HIV/AIDS, CNS lymphoma, and prior allogeneic transplant—DENY if any present; (4) Confirm lymphodepleting chemotherapy will be used unless contraindicated; (5) Submit prior authorization requests to Corporate Transplant Department (1-866-421-5663, fax 502-508-9300, email transplant@humana.com); (6) Update internal workflows to reflect one lifetime dose maximum and 60-day approval duration per clinical review. Obtain prior authorization BEFORE infusion—claims without approval will be denied. Providers must document CD19 expression for ALL cases and hepatitis B screening per ASCO guidelines.