Medicare AdvantagePrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·KY, SC · Oncology·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Kimmtrak (tebentafusp-tebn), a specialty oncology drug. The policy applies to Medicare and Medicaid members in Kentucky and South Carolina. Billing teams must verify prior authorization requirements before dispensing or billing this medication to avoid claim denials.
Action Required
Immediately: Billing and pharmacy teams must implement prior authorization verification for Kimmtrak (HCPCS J9329) for all Kentucky and South Carolina Medicaid members and Medicare beneficiaries. Access the complete policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867fa to identify specific medical necessity criteria, approval processes, and documentation requirements. Update billing system alerts and pharmacy dispensing protocols to flag Kimmtrak claims for prior auth review before submission. Communicate this requirement to oncology providers and pharmacy staff. Claims submitted without prior authorization will be denied.