MedicaidPrior AuthMedium impact
Talvey (talquetamab) (Revised)
Humana·LA · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jul 23, 2026
Summary
This is a revised Humana Medicaid Louisiana policy for Talvey (talquetamab) establishing prior authorization requirements for relapsed/refractory multiple myeloma patients who have received at least four prior lines of therapy including specific drug classes. The policy was revised on July 22, 2026 (2 weeks old) and requires single-agent use only, with approval contingent on meeting all four clinical criteria and excluding patients with disease progression on Talvey.
Action Required
Before January 1, 2026 (retroactive to effective date): Billing team must implement prior authorization requirement for Talvey (talquetamab) claims in Humana Medicaid Louisiana. (1) Update billing system to flag all Talvey requests for mandatory prior auth review. (2) Create authorization checklist requiring verification of: diagnosis of multiple myeloma, relapsed/refractory status, documentation of at least 4 prior therapy lines (including anti-CD38 monoclonal antibody, proteasome inhibitor, and immunomodulatory agent), and confirmation of single-agent use. (3) Train prior auth staff to deny claims if patient has documented disease progression while on Talvey. (4) Ensure prior auth is obtained before claim submission—failure to do so will result in claim denials. (5) Note that approval duration is initial plan year or as determined by clinical review; renewals require reauthorization at plan year end. (6) Alert oncology providers that Talvey must not be used in combination with other agents per policy restrictions.