Medicare AdvantagePrior AuthMedium impact
Erleada (apalutamide) (Revised)
Humana·Oncology, Urology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their prior authorization policy for Erleada (apalutamide), an oral medication for prostate cancer treatment. The policy requires prior authorization for both non-metastatic castration-resistant and metastatic castration-sensitive prostate cancer, with specific criteria including diagnosis confirmation and combination therapy with androgen deprivation therapy.
Action Required
Before January 1, 2026: Billing and clinical teams must implement prior authorization requirements for Erleada (apalutamide) prescriptions for Humana Medicare Advantage members. Update EMR templates to document diagnosis of non-metastatic castration-resistant or metastatic castration-sensitive prostate cancer and confirm concurrent androgen deprivation therapy. Obtain prior authorization before prescribing - claims may be denied without approval.