MedicaidPrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·LA · Oncology, Ophthalmology·Medicaid
Effective date
Dec 1, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid Louisiana revised the Kimmtrak (tebentafusp-tebn) prior authorization policy effective December 1, 2025, with updates as of July 22, 2026. The policy requires prior authorization for this rare cancer treatment and mandates three specific approval criteria: diagnosis of unresectable/metastatic uveal melanoma, HLA-A*02:01-positive status confirmed by assay, and monotherapy use. Claims will be denied if the member has experienced disease progression while on Kimmtrak.
Action Required
By December 1, 2025: Billing and clinical teams must implement prior authorization requirements for all Kimmtrak intravenous solution claims submitted to Humana Medicaid Louisiana. (1) Update billing system to flag all Kimmtrak claims requiring prior auth submission before claims are billed. (2) Providers must document and submit with prior auth requests: proof of unresectable or metastatic uveal melanoma diagnosis, HLA-A*02:01-positive assay results, and confirmation of monotherapy use. (3) Ensure claims are rejected at intake if member has documented disease progression on Kimmtrak (exclusion criterion). (4) Verify member plan year for approval duration or request clinical review determination. (5) Reference www.humana.com/PAL for applicable preauthorization and notification lists and medical coding information. Failure to obtain prior authorization will result in claim denials. This policy applies to Louisiana Medicaid members only.