Medicare AdvantagePrior AuthMedium impact
Lumakras (sotorasib) (Revised)
Humana·Oncology, Hematology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Lumakras (sotorasib), a KRAS G12C inhibitor used to treat certain lung and colorectal cancers. The policy now covers two specific indications with detailed criteria for approval, requiring documented mutations and prior therapies.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Lumakras (sotorasib) prescriptions for Medicare Advantage members. Providers must document KRAS G12C mutation testing results, prior therapies, and specific combination requirements (monotherapy for NSCLC, combination with panitumumab for colorectal cancer). Update prior auth request forms to include required clinical criteria. Claims will be denied without proper prior authorization.