Medicare AdvantagePrior AuthLow impact
Ogsiveo (nirogacestat) (Revised)
Humana·Oncology, General Surgery·Medicare Advantage
Effective date
Feb 28, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established prior authorization requirements for Ogsiveo (nirogacestat), a new medication for treating progressing desmoid tumors. The policy requires members to meet specific criteria including confirmed progressing desmoid tumor diagnosis and use as monotherapy, with exclusions for members who have previously failed on this medication.
Action Required
Immediately: For patients prescribed Ogsiveo (nirogacestat) with Humana Medicare Advantage plans, billing team must initiate prior authorization process before dispensing. Verify patient has progressing desmoid tumor diagnosis, confirm medication will be used as monotherapy, and ensure patient has not previously failed on this medication. Visit www.humana.com/PAL for specific preauthorization requirements and medical coding information.