MedicaidPrior AuthMedium impact
Imdelltra (tarlatamab-dlle)
Humana·LA · Oncology, Pharmacy, Pulmonology·Medicaid
Effective date
Jul 1, 2026
We identified it
Sep 15, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Imdelltra (tarlatamab-dlle), a bispecific T-cell engager for extensive-stage small cell lung cancer (ES-SCLC) with disease progression after platinum-based chemotherapy. The policy requires prior authorization and mandates specific patient monitoring protocols due to serious black box warnings for cytokine release syndrome and neurologic toxicity. Coverage is effective July 1, 2026, with initial and renewal approvals granted on a plan year basis.
Action Required
By June 15, 2026: Billing and clinical teams must implement prior authorization workflow for Imdelltra (tarlatamab-dlle) claims submitted to Humana Medicaid Louisiana. (1) Update billing system to flag all Imdelltra requests as requiring prior authorization; (2) Create or update internal prior authorization checklist to verify: member has ES-SCLC diagnosis (ICD-10: C34.90 or similar SCLC code), documented disease progression on or after platinum-based chemotherapy, and NO prior progression while on Imdelltra; (3) Brief providers and clinical staff on black box warnings and required patient monitoring (22-24 hour monitoring on Cycle 1 Days 1 and 8, 48-hour proximity to healthcare setting); (4) Establish point-of-care communication with providers regarding step-up dosing schedule requirements; (5) For claim submission, reference the Humana PAL website (www.humana.com/PAL) for specific medical coding and preauthorization procedures. Failure to obtain prior authorization will result in claim denials. Review policy at least 30 days prior to effective date to allow adequate system and staffing preparation.