Medicare AdvantagePrior AuthMedium impact
Lenvima (lenvatinib) (Revised)
Humana·Oncology, Endocrinology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage revised their prior authorization policy for Lenvima (lenvatinib) capsules, updating coverage criteria for five cancer indications including renal cell carcinoma, endometrial cancer, thyroid cancer, and hepatocellular carcinoma. The policy requires specific combination therapies and excludes members who have experienced disease progression while on Lenvima.
Action Required
Before January 1, 2026: Billing and prior authorization teams must update Lenvima (lenvatinib) prior authorization requests to include specific combination therapy requirements (with Afinitor for advanced RCC, with Keytruda for first-line RCC and endometrial cancer). Verify patient has not experienced disease progression on prior Lenvima therapy. Update prior auth forms to capture required clinical criteria for each cancer indication. Claims will be denied without proper prior authorization.