Medicare AdvantagePrior AuthLow impact
Caprelsa (vandetanib) (Revised)
Humana·Oncology, Endocrinology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised the prior authorization policy for Caprelsa (vandetanib), a thyroid cancer medication, with expanded coverage criteria now including additional thyroid cancer types. The policy requires prior authorization for this specialty medication with specific diagnostic and disease progression criteria.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Caprelsa (vandetanib) prescriptions for Medicare Advantage patients. Verify patient meets diagnostic criteria for medullary thyroid cancer with symptomatic/progressive disease OR iodine refractory follicular/oncocytic/papillary carcinoma. Claims will be denied without proper prior authorization.