Yescarta™ (axicabtagene ciloleucel) (Revised)

By August 26, 2026: Billing team must implement prior authorization requirements for all Yescarta (axicabtagene ciloleucel) infusions in the billing system and EMR. (1) Update billing software to flag all Yescarta claims as requiring prior authorization before claim submission. (2) Create or update encounter templates to require providers to document: diagnosis (DLBCL, primary mediastinal LBCL, high-grade B-cell, DLBCL ex-FL, or follicular lymphoma), number of prior therapy lines, disease status (refractory/relapsed definition), patient age (≥18), and concurrent lymphodepleting chemotherapy use unless contraindicated. (3) Establish workflow to route all Yescarta requests to the Corporate Transplant Department (1-866-421-5663, Fax: 502-508-9300, Email: transplant@humana.com) for clinical review. (4) Configure system to enforce one-dose-per-lifetime limit and 60-day approval duration. (5) Brief clinical staff on black box warnings: Cytokine Release Syndrome (potentially fatal), neurologic toxicities, and secondary T-cell malignancies. (6) Update denial messaging to reference specific unmet criteria (e.g., insufficient prior therapy lines, disease progression >12 months post-ASCT for 3L cases). Failure to obtain prior authorization will result in claim denial. Claims submitted without meeting all applicable criteria will be rejected.