Medicare AdvantagePrior AuthMedium impact
Votrient (pazopanib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Votrient (pazopanib) effective January 1, 2026, with updates as of April 22, 2026. The policy outlines coverage criteria for five cancer indications (advanced RCC, soft tissue sarcoma, thyroid carcinoma, epithelial ovarian/fallopian tube/primary peritoneal cancer, and uterine sarcoma), with a universal exclusion: members who experienced disease progression on previous Votrient therapy are not eligible for approval. Billing teams must verify prior authorization requirements before claims submission for these oncology cases.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirement for all Votrient (pazopanib) claims under Humana Medicare Advantage plans. (1) Update billing system to route all pazopanib tablet and Votrient tablet claims to require prior auth before submission. (2) Create or update internal checklist requiring verification that member meets indication-specific criteria (e.g., stage IV advanced RCC with clear cell histology for RCC indication; disease progression after prior chemotherapy for soft tissue sarcoma). (3) Screen all prior auth requests for the universal exclusion: confirm member has NOT experienced disease progression on previous Votrient therapy—if yes, flag as likely denial. (4) Providers should document in clinical notes the specific indication, disease stage/status, and prior therapy history to support prior auth submissions. (5) Contact Humana PAL (https://www.humana.com/PAL) for updated preauthorization and notification requirements. Failure to obtain prior authorization will result in claim denials.