Medicare AdvantagePrior AuthMedium impact
Augtyro (repotrectinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Feb 28, 2024
We identified it
Jun 24, 2026
Summary
Humana has updated their prior authorization policy for Augtyro (repotrectinib), a cancer treatment for ROS1-positive NSCLC and NTRK gene fusion-positive solid tumors. The policy establishes specific clinical criteria that must be met for coverage approval under Medicare Advantage plans.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Augtyro (repotrectinib) prescriptions for Medicare Advantage patients. Verify patient meets specific criteria: for ROS1-positive NSCLC patients must have locally advanced/metastatic disease with ROS-1 rearrangement and use as monotherapy; for NTRK gene fusion patients must have metastatic solid tumors or be non-surgical candidates with documented NTRK gene fusion and disease progression. Update prior auth tracking system to monitor plan year duration approvals.