Medicare AdvantagePrior AuthMedium impact
Tecartus™ (brexucabtagene autoleucel) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Feb 19, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its prior authorization policy for Tecartus (brexucabtagene autoleucel) effective February 19, 2026. The policy maintains coverage for relapsed/refractory mantle cell lymphoma and acute lymphoblastic leukemia in adults ≥18 years, with a maximum of one dose per lifetime approved for 60 days. Key requirements include documented CD19 expression for ALL cases, mandatory use with lymphodepleting chemotherapy (unless contraindicated), and exclusion of primary CNS lymphoma cases. All requests must be directed to Humana's Corporate Transplant Department.
Action Required
By February 19, 2026: Billing team must implement the following for all Tecartus (brexucabtagene autoleucel) requests: (1) Update prior authorization workflow to require Corporate Transplant Department contact (1-866-421-5663, fax 502-508-9300, transplant@humana.com) for all requests; (2) Add clinical checklist to prior auth forms requiring verification of: relapsed/refractory disease status, patient age ≥18 years, CD19 expression documentation (for ALL cases), and concurrent lymphodepleting chemotherapy plan; (3) Flag and deny requests for primary CNS lymphoma cases; (4) Document the one-dose-per-lifetime limit in patient records and system to prevent duplicate authorizations; (5) Ensure providers understand the 60-day approval duration for both initial and renewal requests. Providers should be notified that claims will be denied if prior authorization is not obtained or if clinical criteria are not met. Update encounter forms and templates to capture required documentation elements.