Medicare AdvantagePrior AuthHigh impact
Zykadia (ceritinib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Zykadia (ceritinib) prior authorization policy effective January 1, 2026, with a revision date of February 25, 2026. The policy requires prior authorization for Zykadia use in metastatic ALK-positive NSCLC patients, with a critical new requirement that members must have documented medical reasons why first-line ALK inhibitors (Alecensa or Alunbrig) cannot be started or continued before Zykadia approval.
Action Required
By February 25, 2026: Billing and prior authorization teams must immediately implement changes to Humana Medicare Advantage claim processing. (1) Update billing system rules to trigger mandatory prior authorization requests for all Zykadia (ceritinib) prescriptions for metastatic ALK-positive NSCLC. (2) Create or update prior authorization forms to require providers to document: (a) ALK-positive status confirmation, (b) metastatic disease documentation, (c) monotherapy intent, and (d) SPECIFIC medical reasons why Alecensa (alectinib) or Alunbrig (brigatinib) cannot be used (e.g., contraindications, prior treatment failure, patient intolerance). (3) Instruct oncology providers and clinical staff that claims will be DENIED without evidence of attempted or contraindicated first-line ALK inhibitor therapy. (4) Update internal clinical review guidelines to enforce the three-part approval criteria before authorization is granted. (5) Reference the full policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a4cacb0 for all determinations. This policy supersedes any prior Zykadia authorization guidance for Humana Medicare Advantage members.