Medicare AdvantagePrior AuthMedium impact
Tagrisso (osimertinib) (Revised)
Humana·Oncology, Pulmonology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their prior authorization policy for Tagrisso (osimertinib), a cancer medication used to treat non-small cell lung cancer. The policy now covers three specific indications: metastatic NSCLC, adjuvant therapy, and locally advanced unresectable Stage III NSCLC, each with detailed genetic mutation requirements and exclusion criteria.
Action Required
Immediately: Billing and clinical teams must review current Tagrisso (osimertinib) prescriptions for Medicare Advantage patients to ensure compliance with new prior authorization criteria. Verify patients have documented EGFR mutations (exon 19 deletions or exon 21 L858R) and meet specific indication requirements. Update prior authorization request forms to include required genetic testing results and treatment history. Claims may be denied without proper prior authorization and documentation.