MedicaidPrior AuthMedium impact
Talvey (talquetamab) (Revised)
Humana·OH · Oncology·Medicaid
We identified it
Jul 23, 2026
Summary
Humana has issued a revised Prior Authorization policy for Talvey (talquetamab) affecting Ohio Medicaid members. This is a drug-specific prior authorization update that requires billing teams to verify authorization requirements before claims submission. The specific clinical criteria and authorization thresholds are not detailed in the summary-only source provided.
Action Required
Immediately: Billing team must obtain the full policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584816) to identify specific authorization requirements. Update billing system workflows to flag all Talvey (talquetamab) claims for Ohio Medicaid members as requiring prior authorization verification. Provider teams must submit prior authorization requests before dispensing or administering Talvey to Ohio Medicaid patients. Contact Humana's prior authorization department for the revised clinical criteria and approval process. Failure to obtain prior authorization will result in claim denials for Ohio Medicaid members.