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HumanaMedicaid · Prior Auth · Medicaid · LA · Oncology, HematologyHigh impact

Breyanzi® (lisocabtagene maraleucel) (Revised)

Act
by Aug 26, 2026
Effective date
Aug 26, 2026
Identified
Aug 26, 2026

Summary

Humana Louisiana Medicaid has revised its Breyanzi® (lisocabtagene maraleucel) pharmacy coverage policy effective August 26, 2026. The policy establishes prior authorization requirements for this CAR-T cell therapy across six hematologic malignancies (Large B-cell Lymphoma 3L/2L, CLL/SLL, Follicular Lymphoma, Mantle Cell Lymphoma, and Marginal Zone Lymphoma) with specific clinical criteria, exclusions, and a lifetime maximum of one dose per member. Billing teams must implement prior authorization workflows and verify member eligibility against defined clinical criteria before claims submission.

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What to do

by Aug 26, 2026 · 6 steps
01Billing team must update prior authorization system to flag all Breyanzi® (J2335) claims for Louisiana Medicaid members.
02Create verification checklist requiring documentation of: (1) diagnosis confirmation (Large B-cell Lymphoma, CLL/SLL, Follicular Lymphoma, Mantle Cell Lymphoma, or Marginal Zone Lymphoma); (2) prior therapy lines and specific agents (BTK inhibitor, BCL-2 inhibitor required for CLL/SLL and Mantle Cell; minimum 2 lines for others); (3) relapsed/refractory disease status; (4) member age ≥18; (5) concurrent lymphodepleting chemotherapy plan; (6) confirmation of NO prior CD-19 CAR-T therapy, active hepatitis B/C, HIV/AIDS, primary CNS lymphoma, or prior allogeneic transplant.
03Providers must submit prior authorization requests before treatment initiation.
04Update claim denial rules: claims without approved prior authorization or missing clinical documentation will be denied.
05Communicate policy to oncology providers and clinical staff immediately.
06Claims submitted after August 26, 2026 without prior authorization approval will be rejected.

Codes mentioned

J2335

Original notice

Breyanzi® (lisocabtagene maraleucel) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Breyanzi® (lisocabtagene maraleucel) (Revised)MediumEffective Aug 26, 2026 · Medicare AdvantageBreyanzi® (lisocabtagene maraleucel) (Revised)MediumEffective Aug 26, 2026 · MedicaidBreyanzi® (lisocabtagene maraleucel) (Revised)HighEffective Jul 1, 2024 · MedicaidBreyanzi® (lisocabtagene maraleucel) (Revised)MediumEffective Feb 19, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

Related policy hubs

Humana policiesLA policy changesOncologyHematologyCode J2335

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