Medicare AdvantagePrior AuthMedium impact
Avmapki (avutometinib)-Fakzynja (defactinib) Co-Pack (Revised)
Humana·Oncology, OB-GYN·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Avmapki-Fakzynja Co-Pack (avutometinib-defactinib), a new cancer drug combination for treating KRAS-mutated recurrent low-grade serous ovarian cancer. The policy establishes specific criteria including diagnosis confirmation, KRAS mutation documentation, and prior systemic therapy history.
Action Required
By July 23, 2025: Billing and clinical teams must implement prior authorization requirements for Avmapki-Fakzynja Co-Pack prescriptions. Ensure documentation includes: (1) diagnosis of recurrent low-grade serous ovarian cancer, (2) KRAS mutation-positive test results, (3) history of previous systemic therapy, and (4) confirmation both drugs will be used in combination. Update pharmacy prior auth workflows to capture these criteria. Claims without proper authorization will be denied.