MedicaidPrior AuthMedium impact
Amivantamab Products (Rybrevant, Rybrevant Faspro) (Revised)
Humana·IN · Oncology, Pulmonology·Medicaid
Effective date
Sep 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented a new prior authorization policy for Amivantamab products (Rybrevant and Rybrevant Faspro) used to treat specific types of non-small cell lung cancer. The policy establishes detailed criteria for coverage including required EGFR mutation testing and specific treatment combinations.
Action Required
By September 1, 2025: Billing team must implement prior authorization requirements for Rybrevant and Rybrevant Faspro for Humana Medicaid Indiana members. Providers must document EGFR mutation testing results (exon 19 deletions, exon 21 L858R, or exon 20 insertions), disease staging, and treatment history before prescribing. Update EMR templates to include required clinical criteria documentation. Claims will be denied without proper prior authorization.