Medicare AdvantagePrior AuthMedium impact
Krazati (adagrasib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Krazati (adagrasib) prior authorization policy effective February 25, 2026. The policy covers this KRAS G12C inhibitor for two indications: (1) locally advanced/metastatic NSCLC as monotherapy after one prior therapy, and (2) locally advanced/metastatic colorectal cancer in combination with cetuximab after prior chemotherapy. Both indications require documented KRAS G12C mutation and prohibit use in patients who have progressed on prior KRAS G12C inhibitors. Prior authorization is required with initial and renewal approvals valid for 6 months each.
Action Required
By February 25, 2026: Billing and clinical teams must implement prior authorization requirements for Krazati (adagrasib) claims submitted to Humana Medicare Advantage plans. (1) Update billing system to require prior auth for all Krazati requests before claims submission. (2) Ensure clinical staff verify at request time: (a) NSCLC or CRC diagnosis with documented KRAS G12C mutation via FDA-approved test; (b) for NSCLC: at least one prior systemic therapy and monotherapy use planned; (c) for CRC: prior fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy and combination with cetuximab planned. (3) Confirm exclusion criterion: member has NOT progressed on sotorasib or prior adagrasib. (4) Submit prior auth requests through Humana's PAL portal (www.humana.com/PAL) with required clinical documentation. (5) Update encounter templates and provider checklists to capture KRAS mutation status and prior therapy history. Failure to obtain prior authorization will result in claim denials. Note: Approval duration is 6 months for initial and renewal periods; plan accordingly for reauthorization timing.