MedicaidPrior AuthMedium impact
Imdelltra (tarlatamab-dlle) (New)
Humana·LA · Oncology·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Humana Louisiana Medicaid has implemented a new prior authorization policy for Imdelltra (tarlatamab-dlle), a bispecific T-cell engager for extensive-stage small cell lung cancer. Coverage requires patients to have ES-SCLC with disease progression after platinum-based chemotherapy, with denial of approval if disease progression occurs while on Imdelltra. Prior authorization is mandatory before dispensing.
Action Required
By July 1, 2026: Billing and prior authorization teams must implement this new prior authorization requirement for Imdelltra (tarlatamab-dlle) in Louisiana Medicaid claims. Before submitting claims, verify: (1) member has extensive-stage SCLC diagnosis, (2) documented disease progression on or after platinum-based chemotherapy, and (3) no prior disease progression while on Imdelltra. Update billing system to flag Imdelltra claims for mandatory prior authorization submission to Humana Louisiana Medicaid. Train oncology providers and staff to document platinum-based chemotherapy history and disease progression status on prescriptions to support authorization. Contact Humana PAL (https://www.humana.com/PAL) for applicable medical billing codes if submitting inpatient infusion claims. Claims submitted without prior authorization will be denied.