Medicare AdvantagePrior AuthMedium impact
Lytgobi (futibatinib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated the Lytgobi (futibatinib) prior authorization policy effective May 27, 2026. The policy now requires prior authorization for futibatinib use in Medicare Advantage members with unresectable locally advanced or metastatic intrahepatic cholangiocarcinoma (iCCA) with FGFR2 gene fusions/rearrangements who have received prior treatment. Coverage is approved for 6 months initially and at renewal.
Action Required
By May 27, 2026: Billing and prior authorization teams must implement this policy for all Medicare Advantage claims involving Lytgobi (futibatinib). (1) Update billing system to require prior authorization flag for futibatinib requests. (2) Create PA workflow that verifies: member has unresectable locally advanced or metastatic iCCA (Criteria #1), documented FGFR2 gene fusions/rearrangements (Criteria #2), prior treatment history (Criteria #3), and single-agent subsequent therapy use (Criteria #4). (3) Ensure claims are denied if member shows disease progression on Lytgobi (Exclusion #1). (4) Set approval duration reminders for 6-month initial and renewal periods. (5) Train providers to include genetic testing documentation (FGFR2 status) and prior treatment records with PA requests. Failure to obtain prior authorization will result in claim denials for Medicare Advantage members.