Medicare AdvantagePrior AuthMedium impact
Iressa (gefitinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Iressa (gefitinib) tablets used to treat non-small cell lung cancer. The policy requires three specific criteria including metastatic/recurrent NSCLC diagnosis, documented EGFR mutations, and monotherapy use, with 6-month approval periods.
Action Required
Immediately: Billing and clinical teams must ensure prior authorization is obtained for all Iressa (gefitinib) prescriptions for Medicare Advantage patients. Verify patients meet all three criteria: metastatic/recurrent NSCLC diagnosis, documented EGFR exon 19 deletion or exon 21 (L858R) substitution mutation, and monotherapy use. Obtain reauthorization every 6 months. Claims will be denied without proper prior authorization.