Medicare AdvantagePrior AuthMedium impact
Tazverik™ (tazemetostat) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their prior authorization policy for Tazverik (tazemetostat), an oral cancer medication used to treat epithelioid sarcoma and follicular lymphoma. The policy outlines specific criteria including diagnosis requirements, prior therapy history, and EZH2 mutation testing for approval.
Action Required
Before January 1, 2026: Billing team must update prior authorization procedures for Tazverik (tazemetostat) prescriptions for Medicare Advantage patients. Ensure documentation includes diagnosis verification (metastatic/locally advanced epithelioid sarcoma or relapsed/refractory follicular lymphoma), prior therapy history, EZH2 mutation testing results for follicular lymphoma patients, and confirmation of monotherapy use. Visit www.humana.com/PAL for specific medical coding information. Claims without proper prior authorization will be denied.