Medicare AdvantagePrior AuthMedium impact
Zytiga (abiraterone acetate) and generic abiraterone acetate (Revised)
Humana·Oncology, Urology·Medicare Advantage
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its prior authorization policy for Zytiga (abiraterone acetate) and generic abiraterone acetate effective May 27, 2026. The policy requires prior authorization for both brand and generic formulations used to treat metastatic castration-resistant prostate cancer (mCRPC) and castration-sensitive prostate cancer (CSPC). Brand Zytiga now requires documented intolerance or contraindication to generic abiraterone before approval; all approvals require concurrent corticosteroid and androgen deprivation therapy. Members with severe hepatic impairment (Child-Pugh Class C) are excluded from coverage.
Action Required
By May 27, 2026: Billing and clinical teams must implement the following: (1) Establish prior authorization requirement in billing system for all abiraterone acetate claims (brand Zytiga and generic formulations); (2) For brand Zytiga requests, require clinical documentation of member intolerance or contraindication to generic abiraterone before submission; (3) Verify all PA requests include confirmation that member has mCRPC or CSPC diagnosis; (4) Confirm concurrent corticosteroid (prednisone or dexamethasone) and androgen deprivation therapy (prior orchiectomy or LHRH analog) are documented; (5) Screen for Child-Pugh Class C hepatic impairment and flag as exclusion; (6) Update provider templates and encounter forms to collect required clinical documentation; (7) Train oncology practice staff on new requirements. Failure to obtain prior authorization will result in claim denials. Refer to www.humana.com/PAL for claim codes and preauthorization procedures.