Medicare AdvantagePrior AuthMedium impact
Abecma® (idecabtagene vicleucel) (Revised)
Humana·Oncology, Hematology, Pharmacy·Medicare Advantage
Effective date
Feb 19, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Abecma (idecabtagene vicleucel), a CAR-T cell therapy for relapsed/refractory multiple myeloma. The policy maintains strict eligibility criteria requiring at least two prior lines of therapy including specific drug classes, patient age ≥18, and lymphodepleting chemotherapy. Coverage is limited to one lifetime dose approved for 60 days. This revision was effective February 19, 2026, and billing teams must ensure prior authorization is obtained before claims submission.
Action Required
By February 19, 2026: Billing team must implement the following prior authorization requirements for Abecma claims: (1) Verify member meets all five eligibility criteria before claim submission, including diagnosis of relapsed/refractory multiple myeloma per IMWG criteria, minimum two prior systemic therapy lines (immunomodulatory agent, proteasome inhibitor, anti-CD38 monoclonal antibody), age ≥18, and concurrent lymphodepleting chemotherapy; (2) Route all prior authorization requests to Humana's Corporate Transplant Department at 1-866-421-5663, fax 502-508-9300, or email transplant@humana.com; (3) Update billing system to flag Abecma claims as requiring prior authorization; (4) Document that only ONE lifetime dose per member is covered; (5) Ensure providers include black box warning acknowledgments and HBV screening status in authorization request. Failure to obtain prior authorization will result in claim denial. This change applies to Medicare Advantage members only.