Medicare AdvantagePrior AuthMedium impact
Ayvakit (avapritinib) (Revised)
Humana·Oncology, Hematology, Gastroenterology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Ayvakit (avapritinib), effective January 1, 2026. The policy establishes specific criteria for three conditions: gastrointestinal stromal tumor with PDGFRA mutations, indolent systemic mastocytosis, and advanced systemic mastocytosis, with 6-month initial and renewal approval periods.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained before prescribing Ayvakit (avapritinib) for Humana Medicare Advantage patients. Providers must document specific mutation testing for GIST patients (PDGFRA exon 18 mutation), platelet counts above 50 X 10⁹/L for mastocytosis patients, and confirm monotherapy use. Update EMR templates to include required documentation criteria. Claims will be denied without proper prior authorization.