Medicare AdvantagePrior AuthLow impact
Modeyso (dordaviprone) (New)
Humana·Oncology, Neurology, Neurosurgery·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Modeyso (dordaviprone) capsules, a specialty oncology medication for diffuse midline glioma with H3 K27M mutation. Requires prior auth for Medicare Advantage members meeting specific diagnosis and progression criteria.
Action Required
By October 22, 2025: Billing and clinical teams must obtain prior authorization before prescribing Modeyso (dordaviprone) for Medicare Advantage patients. Verify patient has diffuse midline glioma with documented H3 K27M mutation and disease progression/recurrence. Submit prior auth requests through www.humana.com/PAL. Claims will be denied without prior authorization.