Medicare AdvantagePrior AuthMedium impact
Nexavar (sorafenib) (Revised)
Humana·Oncology, Nephrology, Endocrinology +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana updated their Medicare Advantage prior authorization policy for Nexavar (sorafenib) effective January 1, 2026, with specific criteria for renal cell carcinoma, liver carcinoma, thyroid carcinoma, and GIST. The policy requires generic sorafenib be tried first unless there's intolerance or contraindication to the generic version.
Action Required
By January 1, 2026: Billing and clinical teams must ensure prior authorization is obtained for all Nexavar (sorafenib) prescriptions for Medicare Advantage patients. Verify patients meet specific diagnostic criteria and document any intolerance/contraindication to generic sorafenib before requesting brand Nexavar. Update prior authorization workflow to include the four covered indications and exclusion criteria.