MedicaidPrior AuthMedium impact
Emrelis (telisotuzumab vedotin-tllv) (Revised)
Humana·IN · Oncology, Pulmonology·Medicaid
Effective date
Sep 1, 2025
We identified it
Sep 15, 2026
Summary
Humana Medicaid-Indiana has updated its prior authorization policy for Emrelis (telisotuzumab vedotin-tllv), a new oncology drug for treating locally advanced or metastatic non-squamous NSCLC with high c-Met protein overexpression in patients with prior systemic therapy. This is a revised policy effective September 1, 2025, with a revision date of May 27, 2026. Prior authorization is required before dispensing, with specific clinical criteria that must be met for approval.
Action Required
By September 1, 2025: Billing and prior authorization team must implement Emrelis (telisotuzumab vedotin-tllv) prior authorization requirements in the billing system for Humana Medicaid-Indiana members. Specifically: (1) Configure system to flag all Emrelis claims for prior authorization review; (2) Create internal checklist requiring verification of all four approval criteria before submission: locally advanced or metastatic non-squamous EGFR wild-type NSCLC diagnosis, high c-Met protein overexpression (≥50% IHC 3+) confirmed by FDA-approved test, prior systemic therapy documented, and monotherapy use only; (3) Train billing staff to reject claims if member has experienced disease progression on Emrelis; (4) Set approval duration to plan year or as determined through clinical review; (5) Ensure providers submit c-Met testing documentation with prior authorization requests. Direct providers to submit requests through Humana's PAL portal (www.humana.com/PAL) for applicable coding information. Claims submitted without prior authorization or missing required documentation will be denied.