Medicare AdvantagePrior AuthMedium impact
Stivarga (regorafenib) (Revised)
Humana·Oncology, Gastroenterology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised the prior authorization policy for Stivarga (regorafenib), a cancer medication used for hepatobiliary cancers, metastatic colorectal cancer, gastrointestinal stromal tumors, and soft tissue sarcomas. The policy establishes specific criteria that must be met for approval, including diagnosis requirements, progression through prior therapies, and exclusions for patients who have already failed on Stivarga.
Action Required
Before January 1, 2026: Billing and clinical teams must implement prior authorization requirements for Stivarga (regorafenib) for Humana Medicare Advantage patients. Update billing system to flag these cases and ensure providers document specific diagnosis criteria, prior therapy progression, and exclusion factors outlined in the policy. Create clinical checklists for oncology providers to verify all criteria are met before prescribing. Claims without proper prior authorization will be denied.