MedicaidPrior AuthMedium impact
Imdelltra (tarlatamab-dlle) (New)
Humana·IN · Oncology·Medicaid
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Humana Medicaid-Indiana has established a new Prior Authorization policy for Imdelltra (tarlatamab-dlle), a bispecific T-cell engager for treating extensive-stage small cell lung cancer (ES-SCLC) with disease progression after platinum-based chemotherapy. All Imdelltra claims require prior authorization effective July 1, 2026, and approval is contingent on meeting specific clinical criteria and avoiding exclusions related to disease progression while on therapy.
Action Required
By July 1, 2026: Billing team must implement prior authorization requirements for all Imdelltra (tarlatamab-dlle) intravenous solution claims for Humana Medicaid-Indiana members. Update billing system to flag claims requiring prior auth. Providers must document: (1) ES-SCLC diagnosis, (2) prior platinum-based chemotherapy treatment failure/progression, and (3) absence of disease progression while on Imdelltra. Obtain prior authorization before claim submission. Claims submitted without prior authorization or missing required clinical documentation will be denied. Coordinate with clinical team to ensure prescribing providers understand black box warning requirements (CRS/ICANS monitoring and step-up dosing schedule). Reference www.humana.com/PAL for specific medical billing codes.