Medicare AdvantagePrior AuthMedium impact
Kimmtrak (tebentafusp-tebn) (Revised)
Humana·KY, SC · Oncology, Ophthalmology·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana has revised its prior authorization policy for Kimmtrak (tebentafusp-tebn), a rare cancer immunotherapy for metastatic uveal melanoma. The policy requires prior authorization and mandates three specific clinical criteria: HLA-A*02:01 positive disease confirmation, unresectable/metastatic uveal melanoma diagnosis, and monotherapy use only. Members with disease progression on Kimmtrak are excluded from coverage.
Action Required
By July 22, 2026, the billing team must implement the following: (1) Configure billing system to require prior authorization for all Kimmtrak (tebentafusp-tebn) claims for Kentucky and South Carolina Medicaid and Medicare members; (2) Create prior authorization submission checklist requiring documentation of HLA-A*02:01 assay results, unresectable or metastatic uveal melanoma diagnosis, and confirmation of monotherapy use; (3) Flag claims where members have documented disease progression on Kimmtrak for denial; (4) Notify oncology providers that prior authorization is required before dispensing Kimmtrak and that HLA testing results must be attached to all authorization requests; (5) Update internal denial protocols to cite Exclusion #1 (disease progression) when applicable. Failure to obtain prior authorization will result in claim denials. This policy applies only to Kentucky and South Carolina Medicaid members and Medicare beneficiaries.