Medicare AdvantagePrior AuthMedium impact
Yescarta™ (axicabtagene ciloleucel) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Feb 19, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Yescarta (axicabtagene ciloleucel) prior authorization policy effective February 19, 2026, clarifying coverage criteria for three indications: large B-cell lymphoma (3L+), large B-cell lymphoma (2L), and follicular lymphoma. The policy maintains a lifetime limit of one dose per member and requires lymphodepleting chemotherapy unless contraindicated. All requests must be routed to the Corporate Transplant Department.
Action Required
By February 19, 2026: Billing and prior authorization teams must update internal workflow documentation and EMR/billing system templates to reflect the three distinct coverage pathways for Yescarta based on diagnosis and treatment history. For large B-cell lymphoma (3L+), verify members have ≥2 prior systemic therapies and relapsed/refractory disease; for 2L, verify refractoriness to or relapse within 12 months of first-line therapy; for follicular lymphoma, verify ≥2 prior lines and relapsed/refractory status. All members must be ≥18 years old. Ensure all Yescarta prior authorization requests are submitted to Humana Corporate Transplant Department (1-866-421-5663, fax 502-508-9300, email transplant@humana.com). Flag that only one dose per lifetime will be approved. Document that approvals are valid for 60 days or as determined by clinical review. Failure to route through the correct department or meet criteria will result in claim denials.