Medicare AdvantagePrior AuthMedium impact
Torpenz (everolimus) (Revised)
Humana·Oncology, Neurology, Endocrinology·Medicare Advantage
Effective date
Aug 28, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for Torpenz (everolimus), a brand-name cancer medication. All requests must demonstrate intolerance or contraindication to generic everolimus before the brand version will be approved for three specific conditions: SEGA with TSC, angiomyolipoma with TSC, and metastatic breast cancer.
Action Required
Immediately: Billing and clinical teams must implement prior authorization process for Torpenz (everolimus) prescriptions for Humana Medicare Advantage patients. Providers must document patient intolerance or contraindication to generic everolimus and meet specific clinical criteria for SEGA with TSC, angiomyolipoma with TSC, or metastatic breast cancer indications. Update pharmacy prior auth workflows to include these requirements. Claims without proper authorization will be denied.