MedicaidPrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (New)
Humana·OH · Oncology, Dermatology·Medicaid
We identified it
Jul 21, 2026
Summary
Humana has issued a new Prior Authorization policy for Kimmtrak (tebentafusp-tebn), an immunotherapy drug, effective for Ohio Medicaid members. Billing teams must obtain prior authorization before claims submission to avoid denials for this newly covered medication.
Action Required
Immediately: Billing team must implement prior authorization requirement for Kimmtrak (tebentafusp-tebn / J9285) for all Ohio Medicaid claims. Update billing system to flag claims for this HCPCS code requiring prior auth submission before processing. Coordinate with providers and infusion centers administering this drug to ensure prior authorization requests are submitted at least 5-7 business days before treatment. Inform pharmacy and clinical staff of the new requirement. Claims submitted without prior authorization will be denied by Humana Ohio Medicaid.