Medicare AdvantagePrior AuthMedium impact
Vectibix (panitumumab) (Revised)
Humana·FL, KY, SC · Oncology, Hematology·Medicaid
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its Vectibix (panitumumab) prior authorization policy effective January 1, 2024, with updates as of December 17, 2025. The policy covers panitumumab for metastatic colorectal cancer in two distinct scenarios: (1) wild-type RAS patients as monotherapy or in combination with specific chemotherapy regimens, and (2) KRAS G12C-mutated patients in combination with sotorasib. All uses require prior authorization and RAS mutation status documentation; claims for unknown RAS status or after prior progression on panitumumab/cetuximab will be denied.
Action Required
By January 1, 2024 (retroactively now in effect): Billing team must implement prior authorization requirements for all Vectibix (panitumumab) claims in Florida, Kentucky, and South Carolina Medicaid and Medicare Advantage plans. Update billing system to automatically route Vectibix claims to prior auth queue. Establish provider-facing checklist requiring: (1) documentation of metastatic colorectal cancer diagnosis, (2) FDA-approved RAS/KRAS/NRAS mutation test results (wild-type OR KRAS G12C-mutated specifically), and (3) prior chemotherapy regimen documentation. For wild-type RAS cases, confirm medication use is monotherapy post-progression OR combination with CAPEOX/FOLFOX/FOLFIRI OR concurrent irinotecan. For KRAS G12C cases, confirm combination with Lumakras (sotorasib) and prior fluoropyrimidine/oxaliplatin/irinotecan treatment. Reject any claims with unknown RAS mutation status or prior panitumumab/cetuximab progression. Update medical necessity templates and encounter documentation forms to prompt providers for all required criteria. Train billing staff to deny claims immediately if RAS mutation status is undocumented or patient has prior panitumumab/cetuximab failure. Add policy reference to prior auth denial templates for transparency.