MedicaidPrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (New)
Humana·OH · Oncology, Hematology·Medicaid
Effective date
Oct 22, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicaid (Ohio) has established a new prior authorization policy for Kimmtrak (tebentafusp-tebn), a specialized immunotherapy for HLA-A*02:01-positive patients with unresectable or metastatic uveal melanoma. Approval requires three criteria: unresectable/metastatic uveal melanoma diagnosis, documented HLA-A*02:01-positive disease by assay, and use as monotherapy. Claims will be denied without prior authorization and if the patient experiences disease progression on the drug.
Action Required
Before October 22, 2025: Billing team must implement prior authorization requirement for all Kimmtrak (tebentafusp-tebn) claims submitted to Humana Medicaid Ohio. Update billing system to flag Kimmtrak prescriptions for prior auth review. Providers must submit documentation of: (1) unresectable or metastatic uveal melanoma diagnosis, (2) HLA-A*02:01-positive disease assay results, and (3) confirmation of monotherapy use. Designate clinical reviewer to screen for exclusion criterion: deny approval if member has experienced disease progression on Kimmtrak. Without prior authorization, all claims will be denied. Note: Policy applies only to Humana Medicaid Ohio plans; verify member's plan type before applying this requirement.