Medicare AdvantagePrior AuthMedium impact
Hernexeos (zongertinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Hernexeos (zongertinib), a new cancer medication for HER2-mutated non-small cell lung cancer. The policy establishes specific clinical criteria that must be met for approval, including documented HER2 mutations and use as monotherapy.
Action Required
By October 22, 2025: Billing team must update prior authorization workflows for Hernexeos (zongertinib) prescriptions for Medicare Advantage patients. Ensure providers document unresectable or metastatic non-squamous NSCLC diagnosis, positive HER2 mutations via FDA-approved test, and monotherapy use. Claims will be denied without prior authorization approval.