Medicare AdvantagePrior AuthMedium impact
Modeyso (dordaviprone) (New)
Humana·Oncology, Neurology, Neurosurgery·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Modeyso (dordaviprone), a specialized cancer medication for diffuse midline glioma with H3 K27M mutation. This requires pre-approval before dispensing the medication to patients with this rare brain cancer diagnosis.
Action Required
By October 22, 2025: Billing team must update prior authorization procedures for Modeyso (dordaviprone) prescriptions for Humana Medicare Advantage patients. Ensure providers document: 1) diffuse midline glioma diagnosis, 2) H3 K27M mutation confirmation, and 3) disease progression/recurrence after prior therapy. Submit prior auth requests through www.humana.com/PAL before dispensing. Claims will be denied without proper authorization.