Medicare AdvantagePrior AuthMedium impact
Voranigo (vorasidenib) (Revised)
Humana·Oncology, Neurology, Pediatrics·Medicare Advantage
Effective date
Sep 25, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Voranigo (vorasidenib), a targeted therapy for grade 2 gliomas with IDH1/IDH2 mutations. The policy requires prior authorization for this specialty oncology medication when used as single-agent adjuvant therapy post-surgery in patients 12 years and older. Billing teams must implement prior authorization workflows and ensure claims meet three specific clinical criteria or will be denied.
Action Required
Before September 25, 2024 (retroactive): Billing team must identify any Voranigo claims already submitted for Medicare Advantage patients and determine if prior authorization was obtained. For all prospective Voranigo claims: (1) Implement prior authorization requirement in billing system for Voranigo (vorasidenib) tablets for Medicare Advantage members only; (2) Require documentation of all three approval criteria before claim submission: grade 2 astrocytoma or oligodendroglioma diagnosis, documented IDH1 or IDH2 mutation, and single-agent use post-surgery; (3) Alert oncology providers that Voranigo requires prior auth and update claim denial protocols to reference this policy; (4) Train front desk and authorizations staff to route all Voranigo requests through PA process; (5) Submit all retrospective claims from September 25, 2024 forward with prior authorization or expect denials. Check Humana's PAL portal (www.humana.com/PAL) for current medical/procedural coding requirements. Note: Approval duration limits are referenced but not specified in this policy document—contact Humana for renewal parameters.