MedicaidPrior AuthMedium impact
Abecma® (idecabtagene vicleucel) (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicaid (Kentucky) updated its prior authorization policy for Abecma (idecabtagene vicleucel), a CAR-T cell therapy for relapsed/refractory multiple myeloma. The revision effective May 1, 2026, maintains approval for 60 days with a lifetime maximum of one dose and requires documented criteria including prior treatment history, age ≥18, concurrent lymphodepleting chemotherapy, and exclusions for active hepatitis B/C, prior allogeneic transplant, or prior CAR-T therapy. All requests must be referred to the Corporate Transplant Department.
Action Required
By May 1, 2026: Billing team must update prior authorization workflows to ensure all Abecma requests include documentation of: (1) multiple myeloma diagnosis with relapsed/refractory disease per IMWG criteria, (2) at least two prior systemic therapy lines including immunomodulatory agent, proteasome inhibitor, and anti-CD38 monoclonal antibody, (3) patient age ≥18 years, (4) concurrent lymphodepleting chemotherapy plan. Implement exclusion screening for active hepatitis B/C, prior allogeneic transplant, or prior CAR-T therapy. Route all requests through Corporate Transplant Department (1-866-421-5663, fax 502-508-9300, transplant@humana.com). Set system flags to enforce lifetime maximum of one dose per member. Verify Kentucky Medicaid patients have enrollment confirmation. Claims missing required prior authorization will be denied.