Medicare AdvantagePrior AuthMedium impact
Carvykti™ (ciltacabtagene autoleucel) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Feb 19, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Carvykti (ciltacabtagene autoleucel) coverage policy effective February 19, 2026. This is a CAR-T cell immunotherapy for relapsed/refractory multiple myeloma requiring prior authorization. The policy mandates five specific clinical criteria be met before approval, with a maximum of one lifetime dose approved for a 60-day duration. All requests must be routed to Humana's Corporate Transplant Department.
Action Required
By February 19, 2026: (1) Billing and clinical teams must configure the prior authorization system to route all Carvykti requests to Humana's Corporate Transplant Department (1-866-421-5663, fax 502-508-9300, email transplant@humana.com). (2) Update authorization templates to verify all five criteria are documented: (a) multiple myeloma diagnosis, (b) relapsed/refractory disease per IMWG criteria, (c) prior systemic therapy with immunomodulatory agent AND proteasome inhibitor, (d) patient age ≥18, and (e) use with lymphodepleting chemotherapy unless contraindicated. (3) Implement lifetime dose tracking in the authorization system to enforce maximum one-dose-per-lifetime limit. (4) Set approval duration to 60 days unless clinical review determines otherwise. (5) Ensure oncology/hematology providers are notified of black box warnings (CRS, ICANS, Parkinsonism, Guillain-Barré syndrome, HLH/MAS, cytopenias, secondary malignancies) and precautions (HBV screening, infection monitoring, hypogammaglobulinemia monitoring). Claims submitted without prior authorization or violating the one-lifetime-dose limit will be denied.