MedicaidPrior AuthMedium impact
Yescarta™ (axicabtagene ciloleucel) (Revised)
Humana·LA · Hematology, Oncology·Medicaid
Effective date
Aug 26, 2026
We identified it
Aug 27, 2026
Summary
Humana Medicaid Louisiana updated its Yescarta (axicabtagene ciloleucel) prior authorization policy effective August 26, 2026. This is a revision to an existing policy with no substantive coverage changes, but billing teams must ensure prior authorization requests are properly submitted to the Corporate Transplant Department for all three indicated conditions (Large B-Cell Lymphoma 3L, Large B-Cell Lymphoma 2L, and Follicular Lymphoma) with strict adherence to clinical criteria and exclusions.
Action Required
By August 26, 2026: Billing and clinical teams must verify all Yescarta prior authorization requests are routed to Humana Corporate Transplant Department (1-866-421-5663, fax 502-508-9300, email transplant@humana.com) for Medicaid Louisiana members only. Prior to submission, verify: (1) diagnosis is Large B-Cell Lymphoma (DLBCL, primary mediastinal, high-grade, or DLBCL from follicular lymphoma) or Follicular Lymphoma; (2) member meets specific criteria based on line of therapy (2L vs 3L vs follicular); (3) member has NO prior CD-19 targeted therapy, prior CD-19 CAR-T therapy, active hepatitis B/C, HIV/AIDS, or prior allogeneic transplant; (4) member is ≥18 years old; (5) Yescarta will be used with lymphodepleting chemotherapy unless contraindicated. Update EMR/billing templates to capture these elements on encounter forms. Claims submitted without meeting criteria or without prior authorization will be denied. Maximum one dose per lifetime per member.