Medicare AdvantagePrior AuthMedium impact
Isatuximab-irfc Products (Sarclisa, Sarclisa Escena) (Revised)
Humana·FL, KY, SC · Oncology·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Isatuximab-irfc products (Sarclisa, Sarclisa Escena) affecting Medicare and Medicaid members in Florida, Kentucky, and South Carolina. The billing team must implement updated prior authorization requirements for these oncology drugs, though specific clinical criteria and effective dates are not available in this summary-only source.
Action Required
Immediately: Obtain the full policy document from the URL provided (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a586824) to identify specific HCPCS codes for Isatuximab-irfc products and any changes to prior authorization requirements. Billing team must: (1) Identify the applicable HCPCS J-codes for Sarclisa and Sarclisa Escena; (2) Update billing software to trigger prior authorization workflow for these products in FL, KY, and SC Medicaid and Medicare plans; (3) Communicate revised requirements to oncology providers and infusion center staff; (4) Ensure all claims for these products include documented prior authorization before submission. Contact Humana directly if full policy details are unavailable. Claims submitted without required prior authorization will be denied.