MedicaidPrior AuthMedium impact
Emrelis (telisotuzumab vedotin-tllv) (Revised)
Humana·LA · Oncology, Pulmonology·Medicaid
Effective date
Sep 1, 2025
We identified it
Sep 15, 2026
Summary
Humana Louisiana Medicaid has issued a revised prior authorization policy for Emrelis (telisotuzumab vedotin-tllv), effective September 1, 2025, for treating locally advanced or metastatic non-squamous EGFR wild-type NSCLC with high c-Met protein overexpression in patients with prior systemic therapy. The policy requires prior authorization and establishes specific clinical criteria including c-Met testing (≥50% IHC 3+ staining) and monotherapy requirement.
Action Required
By September 1, 2025: Billing and clinical teams must implement prior authorization workflow for Emrelis requests in the billing system. Update oncology department protocols to require: (1) verification of locally advanced or metastatic non-squamous EGFR wild-type NSCLC diagnosis, (2) documentation of high c-Met protein overexpression (≥50% tumor cells with strong 3+ staining via FDA-approved test), (3) evidence of prior systemic therapy, and (4) confirmation of monotherapy use. Create prior auth checklist for providers and oncology staff. Route all Emrelis requests through prior authorization process before dispensing. Claims submitted without prior authorization will be subject to denial. Note: Policy revision date (May 27, 2026) indicates this may have recent updates—verify against Humana's online portal before processing claims.