MedicaidPrior AuthMedium impact
Erbitux (cetuximab) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Erbitux (cetuximab), adding new coverage criteria for KRAS G12C-mutated colorectal cancer and updating requirements for BRAF V600E-mutated colorectal cancer. The policy now requires specific combination therapies and documented genetic mutations for approval.
Action Required
Immediately: Billing team must ensure prior authorization requests for Erbitux (cetuximab) include documented genetic mutation status (BRAF V600E or KRAS G12C for colorectal cancer) and specify combination therapy partners (Braftovi for BRAF mutations, Krazati for KRAS G12C mutations). Update prior auth forms to capture required genetic testing results and combination drug information. Claims without proper mutation documentation will be denied.