Medicare AdvantagePrior AuthMedium impact
Afinitor/Afinitor Disperz (everolimus) (Revised)
Humana·Oncology, Neurology, Nephrology +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage revised their prior authorization policy for Afinitor/Afinitor Disperz (everolimus) effective January 1, 2026. The policy requires prior authorization for all covered indications including TSC-associated seizures, advanced renal cell carcinoma, neuroendocrine tumors, SEGA with TSC, angiomyolipoma with TSC, and metastatic breast cancer, with specific clinical criteria that must be met for each indication.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Afinitor/Afinitor Disperz (everolimus) prescriptions for Medicare Advantage patients. Providers must document specific clinical criteria including diagnosis, disease stage, previous treatments, and exclusion criteria based on the indication. Update billing system to flag these medications for prior auth requirement. Claims will be denied without proper prior authorization.