MedicaidPrior AuthMedium impact
Tecartus™ (brexucabtagene autoleucel) (Revised)
Humana·KY · Oncology, Hematology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 25, 2026
Summary
This is a revised Medicaid (Kentucky) prior authorization policy for Tecartus (brexucabtagene autoleucel), a CAR-T cell therapy for relapsed/refractory mantle cell lymphoma and acute lymphoblastic leukemia in adults. The policy was last revised May 1, 2026 (1 day ago). Billing teams must ensure all Tecartus requests include prior authorization through Humana's Corporate Transplant Department and verify patient meets strict clinical criteria including age ≥18, disease status, and absence of specific contraindications (prior CAR-T therapy, active hepatitis B/C, HIV/AIDS, CNS lymphoma, or prior allogeneic transplant). Maximum one dose per lifetime applies.
Action Required
By May 15, 2026: Billing team must implement the following: (1) Route all Tecartus (brexucabtagene autoleucel) authorization requests to Humana Corporate Transplant Department at 1-866-421-5663 (Fax: 502-508-9300, Email: transplant@humana.com) BEFORE claim submission; (2) Verify prior to authorization submission that patient meets ALL clinical criteria for their indication (MCL: diagnosis + relapsed/refractory + age ≥18 + concurrent lymphodepleting chemo unless contraindicated; ALL: B-cell precursor + relapsed/refractory/2nd+ relapse + CD19 expression documented + age ≥18 + concurrent lymphodepleting chemo unless contraindicated); (3) Screen for ALL exclusions (prior CD19-targeted CAR-T therapy, active hepatitis B/C, HIV/AIDS, primary CNS lymphoma, prior allogeneic transplant) and flag if present—approval unlikely; (4) Document in claims system that approval duration is 60 days or per clinical review, with ONE dose maximum per patient lifetime; (5) Flag any secondary malignancy reports post-treatment and refer to Kite at 1-844-454-5483; (6) Update encounter forms and billing workflows to remind providers of lymphodepleting chemotherapy requirement. Claims submitted without prior authorization will be denied.