MedicaidPrior AuthMedium impact
Talvey (talquetamab) (Revised)
Humana·IN · Oncology·Medicaid
Effective date
Nov 1, 2025
We identified it
Jul 23, 2026
Summary
This is a revised prior authorization policy for Talvey (talquetamab) for Indiana Medicaid covering relapsed/refractory multiple myeloma. The policy requires prior authorization and specifies strict criteria: patients must have multiple myeloma diagnosis, relapsed/refractory disease, at least four prior lines of therapy (including anti-CD38 monoclonal antibody, proteasome inhibitor, and immunomodulatory agent), and Talvey must be used as a single agent. Claims will be denied if the patient has experienced disease progression while on Talvey.
Action Required
By November 1, 2025: Billing team must implement prior authorization requirement in billing system for all Talvey (talquetamab) claims under Indiana Medicaid. Before submission, verify and document: (1) Multiple myeloma diagnosis, (2) Relapsed/refractory disease status, (3) Patient has received ≥4 prior lines of therapy including anti-CD38 monoclonal antibody (daratumumab), proteasome inhibitor (bortezomib), and immunomodulatory agent (lenalidomide), and (4) Talvey is being prescribed as single agent therapy. Flag and deny any claims where patient has documented disease progression on Talvey. Provide prior auth requirements checklist to oncology providers. Update claim submission templates to require evidence of treatment history and disease status. Notify providers of REMS program restrictions (Tecvayli and Talvey REMS). Claims submitted without prior authorization or missing required documentation will be denied.