MedicaidPrior AuthMedium impact
Imdelltra (tarlatamab-dlle)
Humana·IN · Oncology, Pulmonology·Medicaid
Effective date
Jul 1, 2026
We identified it
Sep 15, 2026
Summary
Humana Indiana Medicaid has established a new Prior Authorization policy for Imdelltra (tarlatamab-dlle), a bispecific T-cell engager indicated for extensive-stage small cell lung cancer (ES-SCLC) with disease progression after platinum-based chemotherapy. Effective July 1, 2026, all claims for this drug require prior authorization. The policy includes two mandatory approval criteria and one exclusion (disease progression while on Imdelltra), plus black box warnings requiring step-up dosing and intensive monitoring for cytokine release syndrome and neurologic toxicity.
Action Required
By June 15, 2026: Billing and clinical teams must implement prior authorization workflow for Imdelltra (tarlatamab-dlle) claims for Indiana Medicaid members. (1) Update billing software and claims submission systems to flag all Imdelltra requests for mandatory prior auth. (2) Create clinical review checklist requiring verification of: diagnosis of ES-SCLC (ICD-10: C34.30 or C34.31), platinum-based chemotherapy treatment history, and absence of disease progression on prior Imdelltra therapy. (3) Brief providers and clinical staff on approval criteria and black box warnings, especially step-up dosing requirements and 22-24 hour monitoring on Cycle 1 Days 1 and 8. (4) Establish contact pathway with Humana for prior auth submissions using the Preauthorization and Notification List (PAL) at www.humana.com/PAL for claim codes. Claims submitted without prior authorization will be denied. Initial approvals are valid for plan year duration; renewals require clinical review.