Medicare AdvantagePrior AuthMedium impact
Xalkori (crizotinib) (Revised)
Humana·Oncology, Hematology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana has revised its Xalkori (crizotinib) prior authorization policy effective January 1, 2026, with updates made February 25, 2026. The policy clarifies coverage criteria for three cancer indications: metastatic/recurrent NSCLC (requiring ALK-positivity, ROS1-positivity, or MET exon 14 mutation with documented medical reason for alternative ALK inhibitors), relapsed/refractory ALK-positive ALCL in patients 1-21 years old, and unresectable/recurrent/refractory ALK-positive IMT in patients over 1 year old. All uses require prior authorization.
Action Required
By January 1, 2026: Billing and authorization team must implement prior authorization requirements for all Xalkori (crizotinib) claims across three indications. For NSCLC claims, verify documentation of metastatic/recurrent disease AND (ALK-positivity with documented medical reason why alectinib or brigatinib cannot be used, OR ROS1-positivity, OR MET exon 14 mutation). For ALCL claims, verify relapsed/refractory disease, ALK-positivity, and patient age 1-21 years. For IMT claims, verify unresectable/recurrent/refractory disease, ALK-positivity, and patient age over 1 year. Ensure pharmacy billing staff submits prior authorization requests with required genetic/molecular testing documentation before dispensing. Update prior authorization submission templates and checklist to capture all three indications separately. Note: Approval duration periods are blank in this policy document—contact Humana to confirm initial and renewal authorization durations. Failure to obtain prior authorization will result in claim denials.