Medicare AdvantagePrior AuthLow impact
Romvimza (vimseltinib) (Revised)
Humana·Oncology, Orthopedics, General Surgery·Medicare Advantage
Effective date
May 28, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization requirements established for Romvimza (vimseltinib), a kinase inhibitor used to treat symptomatic tenosynovial giant cell tumor (TGCT). Medicare Advantage members must meet specific criteria including confirmed TGCT diagnosis and demonstration that surgical resection would cause worsening functional limitation or severe morbidity.
Action Required
By May 28, 2025: Billing team must update prior authorization system to require approval for Romvimza (vimseltinib) prescriptions for Medicare Advantage members. Providers must document TGCT diagnosis and medical justification that surgery would cause functional limitation or severe morbidity. Monitor for hepatotoxicity warnings and contraindications with FD&C Yellow dyes. Claims will be denied without proper prior authorization.