Medicare AdvantagePrior AuthMedium impact
Itovebi (inavolisib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Dec 18, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Itovebi (inavolisib), a new breast cancer medication. This policy establishes specific criteria for coverage including PIK3CA mutation testing and combination therapy requirements for hormone receptor-positive, HER2-negative metastatic breast cancer patients.
Action Required
Effective December 18, 2024: Billing team must update prior authorization requirements for Itovebi (inavolisib) prescriptions for Humana Medicare Advantage patients. Ensure providers document PIK3CA mutation testing, HR-positive/HER2-negative breast cancer diagnosis, endocrine resistance, and planned combination therapy with palbociclib and fulvestrant before submitting prior auth requests. Claims without proper authorization will be denied.