MedicaidPrior AuthMedium impact
Amivantamab Products (Rybrevant, Rybrevant Faspro) (Revised)
Humana·LA · Oncology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Amivantamab Products (Rybrevant, Rybrevant Faspro) for Louisiana Medicaid patients with non-small cell lung cancer. The policy establishes specific criteria for coverage including required EGFR mutations, disease staging, and treatment combinations.
Action Required
By September 1, 2025: Billing team must ensure prior authorization is obtained for all Rybrevant and Rybrevant Faspro claims for Louisiana Medicaid patients. Verify patients meet specific criteria including EGFR mutation testing, disease progression documentation, and appropriate combination therapy requirements before submitting claims. Update encounter forms to remind oncologists of prior auth requirements.