Medicare AdvantagePrior AuthMedium impact
Tarceva (erlotinib) (New)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Tarceva (erlotinib) effective January 1, 2026, covering three cancer indications: renal cell carcinoma, pancreatic cancer, and non-small cell lung cancer. The policy requires specific clinical criteria to be met for each indication, with brand Tarceva requiring documented intolerance or contraindication to generic erlotinib.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Tarceva (erlotinib) prescriptions for Medicare Advantage members. Update pharmacy systems to flag these medications for prior auth. Providers must document specific clinical criteria including cancer diagnosis, staging, genetic mutations (for NSCLC), and combination therapy requirements (for pancreatic cancer). For brand Tarceva requests, document intolerance or contraindication to generic erlotinib. Claims without prior authorization will be denied.