Medicare AdvantagePrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·KY, SC · Oncology, Hematology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Kimmtrak (tebentafusp-tebn) prior authorization policy effective October 22, 2025, for Medicare and Medicaid (Kentucky and South Carolina). The policy requires prior authorization for this rare cancer immunotherapy targeting HLA-A*02:01-positive unresectable or metastatic uveal melanoma patients. Key criteria include HLA-A*02:01 genetic confirmation and monotherapy use; patients with prior disease progression on Kimmtrak are excluded from coverage.
Action Required
By October 22, 2025: (1) Billing team must update the prior authorization system to require approval for all Kimmtrak (tebentafusp-tebn) claims for Medicare and Medicaid members in Kentucky and South Carolina. (2) Configure system to verify three mandatory approval criteria before claim processing: unresectable/metastatic uveal melanoma diagnosis, HLA-A*02:01 positive status by assay, and monotherapy (no combination therapy). (3) Flag and deny any claims for members with documented prior disease progression on Kimmtrak. (4) Update prior authorization request templates and provider communication materials to reference the October 22, 2025 revision date. (5) Train billing and authorization staff on the HLA-A*02:01 genetic testing requirement and exclusion criteria. (6) Note that approval duration is plan year or clinical review determination. Failure to implement prior authorization will result in claim denials for non-compliant requests.