Medicare AdvantagePrior AuthMedium impact
Imdelltra (tarlatamab-dlle) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Aug 28, 2024
We identified it
Sep 15, 2026
Summary
Humana updated its Imdelltra (tarlatamab-dlle) prior authorization policy for extensive-stage small cell lung cancer (ES-SCLC) effective August 28, 2024, with most recent revisions as of April 22, 2026. The policy requires prior authorization for this bispecific T-cell engager therapy and specifies two approval criteria: ES-SCLC diagnosis and disease progression after platinum-based chemotherapy. Key requirement: members cannot have experienced disease progression while already on Imdelltra, and prescribers must follow step-up dosing and 48-hour monitoring protocols due to black box warnings for cytokine release syndrome and neurologic toxicity.
Action Required
By August 28, 2024 (retroactively, if not already implemented): Billing team must configure prior authorization workflow for Imdelltra (tarlatamab-dlle) infusions in the practice management system. Update encounter templates and clinical documentation requirements to capture: (1) diagnosis confirmation of extensive-stage SCLC, (2) prior platinum-based chemotherapy treatment history with progression dates, and (3) no prior progression on Imdelltra. Coordinate with oncology providers to ensure prior authorization requests are submitted before treatment initiation. Flag any claims for Imdelltra without documented prior authorization approval for immediate denial review. Update provider referral guidance for applicable Medicaid plans (Florida, Kentucky, South Carolina) and Medicare Advantage members. Consequences: Claims submitted without prior authorization approval will be denied; treatment delays may occur if documentation is incomplete.