Medicare AdvantagePrior AuthMedium impact
Alecensa (alectinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Alecensa (alectinib) for treating ALK-positive non-small cell lung cancer. The policy now includes specific criteria for both metastatic and adjuvant treatment scenarios, with exclusions for members who have progressed on therapy or exceeded two years of adjuvant treatment.
Action Required
By January 1, 2026: Billing team must update prior authorization protocols for Alecensa (alectinib) prescriptions for Humana Medicare Advantage members. Ensure providers document ALK-positive status, treatment indication (metastatic vs adjuvant), monotherapy use, and complete tumor resection for adjuvant cases. Verify members have not exceeded two years of treatment for adjuvant therapy and have not experienced disease progression. Claims will require prior authorization approval.