Medicare AdvantagePrior AuthMedium impact
Ibrance (palbociclib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana updated its prior authorization policy for Ibrance (palbociclib), a breast cancer medication for Medicare Advantage members. The policy now includes a new indication for PIK3CA-mutated metastatic breast cancer requiring combination therapy with Itovebi and fulvestrant, while maintaining existing criteria for other breast cancer indications.
Action Required
By January 1, 2025: Prior authorization team must update Humana Medicare Advantage prior auth protocols for Ibrance (palbociclib) to include new PIK3CA-mutated breast cancer indication requiring FDA-approved genetic testing documentation and combination with Itovebi and fulvestrant. Ensure all requests document HR-positive/HER2-negative status and exclude patients with prior CDK 4/6 inhibitor progression. Update clinical staff on new 6-month approval durations for all indications.