Medicare AdvantagePrior AuthMedium impact
Xtandi (enzalutamide) (Revised)
Humana·Oncology, Urology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Xtandi (enzalutamide) prior authorization policy effective January 1, 2026, with updates as of May 27, 2026. The policy now covers four prostate cancer indications (metastatic castration-resistant, non-metastatic castration-resistant, metastatic castration-sensitive, and non-metastatic castration-sensitive with high-risk biochemical recurrence) with specific clinical criteria and a blanket exclusion for members who have experienced disease progression while on Xtandi. All Xtandi requests require prior authorization before dispensing.
Action Required
By January 1, 2026: Billing and clinical teams must update prior authorization workflows to require PA submission for all Xtandi (enzalutamide) prescriptions across all four approved indications. Ensure EMR/billing system flags any member with documented disease progression while on Xtandi as an exclusion that will result in denial. For non-metastatic castration-sensitive prostate cancer specifically, verify documentation of biochemical recurrence with PSA doubling time ≤9 months, PSA ≥1 ng/mL post radical prostatectomy, or screening PSA ≥2 ng/mL above nadir post radiotherapy. Train clinical staff and providers on the new criteria, particularly the requirement for androgen deprivation therapy (bilateral orchiectomy or LHRH analog) for non-metastatic and metastatic castration-sensitive indications. Update prior authorization request templates and submission protocols with Humana. Claims submitted without prior authorization will be denied. Reference the current policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a53f1ff for most recent updates.