Medicare AdvantagePrior AuthMedium impact
Yonsa (abiraterone acetate) (Revised)
Humana·Oncology, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Yonsa (abiraterone acetate) prior authorization policy effective January 1, 2026, with updates as of May 27, 2026. The policy now requires prior authorization for Yonsa tablet coverage for metastatic castration-resistant prostate cancer (mCRPC) when used in combination with methylprednisolone, and adds a new exclusion criterion denying approval for members who have experienced disease progression while on Yonsa. Billing teams must verify all three approval criteria are met before claims submission and flag any prior therapy history with generic abiraterone acetate.
Action Required
By December 31, 2025: Billing team must implement prior authorization requirements for all Yonsa (abiraterone acetate) claims under Humana Medicare Advantage plans. Update billing software and EMR systems to require: (1) verification of metastatic CRPC diagnosis, (2) confirmation of combination therapy with methylprednisolone, and (3) documentation of prior intolerance or failure with generic abiraterone acetate. Add screening logic to identify and deny claims for members with documented disease progression on Yonsa. Update claim submission procedures to include prior authorization request forms before dispensing. Failure to obtain prior authorization will result in claim denials and member out-of-pocket costs. Coordinate with pharmacy team and oncology providers to ensure proper documentation at time of prescription.