Medicare AdvantagePrior AuthMedium impact
Lazcluze (lazertinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Oct 23, 2024
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Lazcluze (lazertinib) for Medicare Advantage plans, requiring specific NSCLC diagnosis criteria, documented EGFR mutations, and combination therapy with amivantamab products. This is a new cancer drug requiring strict approval criteria for coverage.
Action Required
Immediately: Billing and clinical teams must implement prior authorization requirements for Lazcluze (lazertinib) prescriptions for Medicare Advantage patients. Ensure documentation includes: locally advanced or metastatic NSCLC diagnosis, EGFR exon 19 deletions or exon 21 L858R mutations, and concurrent amivantamab therapy. Visit www.humana.com/PAL for specific medical coding requirements. Claims without prior authorization will be denied.