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HumanaMedicare Advantage · Prior Auth · Medicare Advantage · Oncology, HematologyMedium impact

Breyanzi® (lisocabtagene maraleucel) (Revised)

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

Summary

Humana Medicare Advantage has revised its Breyanzi® (lisocabtagene maraleucel) prior authorization policy effective August 26, 2026. The policy covers this CAR-T cell therapy for six indications (Large B-cell Lymphoma at 2L and 3L, CLL/SLL, Follicular Lymphoma, Mantle Cell Lymphoma, and Marginal Zone Lymphoma) with specific clinical criteria for each. All approvals are limited to one dose per lifetime with 60-day initial and renewal authorization periods. Billing teams must ensure prior authorization is obtained before claims submission and verify all clinical criteria are met.

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What to do

by Aug 26, 2026 · 6 steps
01Billing team must implement prior authorization requirements for all Breyanzi® (lisocabtagene maraleucel) claims submitted under Humana Medicare Advantage.
02Update billing system to flag claims requiring PA and create internal checklist for providers to verify: (1) qualifying diagnosis (Large B-cell Lymphoma 2L/3L, CLL/SLL, Follicular, Mantle Cell, or Marginal Zone Lymphoma), (2) appropriate treatment lines and refractory/relapsed status per indication, (3) age ≥18 years, (4) use with lymphodepleting chemotherapy unless contraindicated, and (5) no primary CNS lymphoma diagnosis.
03Configure system to enforce one-dose-per-lifetime limit.
04Providers must submit PA requests 14+ days before planned infusion.
05Note: This is a Medicare Advantage-specific policy; verify coverage with individual plan formularies.
06Claims submitted without prior authorization 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

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