Medicare AdvantagePrior AuthLow impact
Ojemda (tovorafenib) (Revised)
Humana·Oncology, Pediatrics, Neurology·Medicare Advantage
Effective date
Jun 26, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Ojemda (tovorafenib), a kinase inhibitor for pediatric low-grade glioma patients 6+ months old with specific BRAF mutations. Prior authorization is required with specific diagnostic and genetic testing criteria that must be met before approval.
Action Required
Immediately: Billing team must update prior authorization requirements for Ojemda (tovorafenib) prescriptions for Humana Medicare Advantage patients. Verify patients have documented relapsed/refractory pediatric low-grade glioma with BRAF fusion, rearrangement, or V600E mutation before submitting claims. Route all Ojemda requests through Humana's prior authorization process at www.humana.com/PAL. Claims without prior authorization will be denied.