Medicare AdvantagePrior AuthMedium impact
Fyarro (sirolimus protein-bound particles for injectable suspension) (Revised)
Humana·FL, KY, SC · Oncology, Pharmacy·Pharmacy
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its prior authorization policy for Fyarro (sirolimus protein-bound particles for injectable suspension) effective June 24, 2026. The policy covers this mTOR inhibitor for adult patients with locally advanced unresectable or metastatic perivascular epithelioid cell tumor (PEComa) as monotherapy. Billing teams must ensure prior authorization is obtained before claim submission for Medicare and Medicaid members in Florida, Kentucky, and South Carolina.
Action Required
By June 24, 2026: Billing and prior authorization teams must implement the following: (1) Update the billing system and prior authorization workflows to require prior authorization for all Fyarro claims for members in Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina plans; (2) Configure system rules to verify that the member meets both approval criteria—diagnosis of locally advanced unresectable or metastatic PEComa AND that Fyarro is being administered as monotherapy; (3) Ensure clinical review includes screening for exclusions: history of severe hypersensitivity to sirolimus, rapamycin derivatives, or albumin, AND disease progression on prior Fyarro therapy; (4) Update internal clinical documentation guidelines to capture drug interaction information (strong CYP3A4/P-gp inhibitor/inducer avoidance and moderate/weak CYP3A4 inhibitor dose adjustments); (5) Verify provider claim codes through www.humana.com/PAL for the applicable preauthorization and notification lists. Failure to obtain prior authorization will result in claim denials. This is a rare disease drug with limited volume; coordinate with oncology providers and pharmacy teams for implementation.