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HumanaMedicaid · Prior Auth · Medicaid · KY · Hematology, OncologyMedium impact

Breyanzi® (lisocabtagene maraleucel) (Revised)

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

Summary

Humana Kentucky Medicaid updated the Breyanzi® (lisocabtagene maraleucel) prior authorization policy effective August 26, 2026. This is a revision to the existing policy with refined coverage criteria across multiple B-cell lymphoma indications. The policy requires prior authorization for all Breyanzi products and specifies strict eligibility requirements, treatment history thresholds, and exclusionary conditions. Maximum one dose per lifetime is approved with 60-day authorization duration.

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What to do

by Aug 26, 2026 · 8 steps
01Billing and prior authorization teams must review and implement updated Breyanzi coverage criteria in the prior auth submission system.
02Update system edits to enforce the maximum one-dose-per-lifetime limitation.
03Configure prior auth forms to verify all five inclusion criteria for each indication (Large B-cell Lymphoma 3L, Mantle Cell, Large B-cell 2L, CLL/SLL, Follicular Lymphoma).
04Ensure claims are flagged if member has received prior CD-19 CAR-T therapy, active hepatitis B/C, HIV/AIDS, CNS lymphoma diagnosis, or prior allogeneic transplant.
05Train prior auth staff on the specific treatment history requirements (e.g., BTK inhibitor requirement for mantle cell and CLL/SLL, two or more prior lines for most indications).
06Document that lymphodepleting chemotherapy must be used unless contraindicated.
07Update encounter templates and clinical team communication to highlight the one-lifetime-dose restriction.
08Claims submitted without prior authorization or violating exclusion criteria will be denied.

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)HighEffective 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

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