Medicare AdvantagePrior AuthMedium impact
Libtayo® (cemiplimab-rwlc) (Revised)
Humana·FL, KY, SC · Oncology·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Libtayo (cemiplimab-rwlc) prior authorization policy effective December 17, 2025, covering four indications: cutaneous squamous cell carcinoma, adjuvant CSCC, basal cell carcinoma, and NSCLC. The policy applies to Medicare, Medicaid (Florida, Kentucky, South Carolina), and requires prior authorization for all covered indications with specific clinical criteria and exclusions based on prior PD-1/PD-L1 inhibitor use.
Action Required
By December 17, 2025: Billing team must implement prior authorization requirements for all Libtayo (cemiplimab-rwlc) claims in the billing system for Medicare, Medicaid (FL, KY, SC) members. Add clinical criteria validation to prior auth submission process: (1) For CSCC: verify locally advanced/metastatic disease not amenable to surgery/radiation, confirm monotherapy use, and check no prior PD-1/PD-L1 progression. (2) For adjuvant CSCC: verify high-risk recurrence post-surgery/radiation. (3) For BCC: verify locally advanced/metastatic, prior hedgehog pathway inhibitor treatment or documented inappropriateness, confirm monotherapy, and check no prior PD-1/PD-L1 progression. (4) For NSCLC: verify no EGFR/ALK/ROS-1 aberrations, locally advanced/metastatic disease, and either high PD-L1 expression (TPS ≥50%) as monotherapy OR combination with platinum chemotherapy as first-line. Initial approval valid 6 months; renewals valid 6 months. Billing staff must verify member state eligibility (FL, KY, SC for Medicaid) and communicate approval duration to providers. Failure to obtain prior authorization will result in claim denials.