Medicare AdvantagePrior AuthMedium impact
Vizimpro (dacomitinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Vizimpro (dacomitinib) prior authorization policy effective January 1, 2024, with a recent revision dated January 28, 2026. The policy requires prior authorization for Vizimpro as a single-agent, first-line treatment for metastatic NSCLC in patients with documented EGFR exon 19 deletion or exon 21 (L858R) mutation. Initial approval is for 6 months with 6-month renewals.
Action Required
By February 28, 2026: Billing and clinical teams must implement prior authorization requirements for all Vizimpro (dacomitinib) claims submitted to Humana Medicare Advantage plans. Update billing system to require: (1) Verification of metastatic NSCLC diagnosis, (2) Documentation of EGFR exon 19 deletion or exon 21 (L858R) mutation from FDA-approved test, and (3) Confirmation that Vizimpro is being used as single-agent first-line therapy. Add prior auth workflow to encounter templates and claims submission process. Ensure prior auth requests reference this revised policy dated 1/28/2026. Train providers and billing staff on the three approval criteria. Set calendar reminders for 6-month renewal submissions. Failure to obtain prior authorization will result in claim denials from Humana Medicare Advantage.