MedicaidPrior AuthMedium impact
Yescarta™ (axicabtagene ciloleucel) (Revised)
Humana·LA · Hematology, Oncology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Louisiana Medicaid revised its Yescarta (axicabtagene ciloleucel) prior authorization policy effective May 1, 2026, maintaining coverage for relapsed/refractory large B-cell lymphoma (2L and 3L) and follicular lymphoma with specific clinical criteria. The policy requires prior authorization, limits approval to 60 days per dose with a maximum of one lifetime dose, and maintains the same exclusion criteria including prior CD-19 targeted therapy and certain infections. Billing teams must ensure all Yescarta requests include mandatory prior authorization through the Corporate Transplant Department.
Action Required
By May 1, 2026: Billing and prior authorization teams must ensure all Yescarta (axicabtagene ciloleucel) requests for Humana Louisiana Medicaid members follow the revised criteria. Specifically: (1) Verify member meets indications (large B-cell lymphoma 2L or 3L, or follicular lymphoma after ≥2 lines of therapy with relapsed/refractory disease); (2) Confirm member has no exclusions (no prior CD-19 targeted therapy, no prior CAR-T, no active HBV/HCV, no HIV/AIDS, no prior allogeneic transplant); (3) Route all requests to Corporate Transplant Department (1-866-421-5663, Fax: 502-508-9300, Email: transplant@humana.com); (4) Approve for maximum 60 days per clinical review with ONE lifetime dose limit; (5) Update billing system to flag any requests exceeding one lifetime dose for denial. Claims submitted without prior authorization or exceeding the one-dose-per-lifetime limit will be denied. Providers and clinical staff must document disease status (progressive, stable, or progression ≤12 months post-ASCT for 3L cases; refractory or relapse ≤12 months post-first-line for 2L cases) in prior auth submissions.