Medicare AdvantagePrior AuthMedium impact
Braftovi (encorafenib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Braftovi (encorafenib) for melanoma, colorectal cancer, and metastatic non-small cell lung cancer, requiring specific BRAF mutations and combination therapies. The policy includes strict exclusion criteria for patients on certain concurrent medications or those who have failed prior BRAF/MEK therapy.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Braftovi (encorafenib) prescriptions for Humana Medicare Advantage patients. Providers must document BRAF V600 mutations, specific cancer diagnoses (melanoma, colorectal, or NSCLC), required combination therapies (binimetinib for melanoma/NSCLC, cetuximab for colorectal), and confirm patients are not on excluded concurrent medications. Update EMR templates to capture required documentation criteria.