Medicare AdvantagePrior AuthMedium impact
Lorbrena (lorlatinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Lorbrena (lorlatinib), a specialized medication for non-small cell lung cancer with specific genetic markers. The policy establishes strict criteria for coverage including required documentation of ALK or ROS-1 positivity and specific progression requirements after other targeted therapies.
Action Required
By January 1, 2026: Providers treating non-small cell lung cancer patients must ensure prior authorization is obtained for Lorbrena (lorlatinib) prescriptions for Humana Medicare Advantage members. Verify patients meet all criteria including documented ALK or ROS-1 positivity and progression on specified prior therapies. Update EMR templates to include required documentation checklist for genetic testing results and prior treatment history. Claims will be denied without proper prior authorization.