Medicare AdvantagePrior AuthLow impact
Koselugo (selumetinib) (Revised)
Humana·Oncology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana updated its Koselugo (selumetinib) prior authorization policy for Medicare Advantage members with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas. The policy requires prior authorization for this drug when used as monotherapy and denies approval if the member has experienced disease progression on the medication. This is a routine policy revision dated March 25, 2026.
Action Required
Before submitting Koselugo claims for Medicare Advantage members: (1) Billing team must verify that prior authorization is obtained before processing any Koselugo (selumetinib) prescriptions; (2) Confirm member has documented diagnosis of symptomatic, inoperable plexiform neurofibromas related to NF1; (3) Verify the drug is being used as monotherapy (not in combination with other treatments); (4) Check member's treatment history to ensure no prior disease progression on Koselugo has been documented, as this is an exclusion criterion; (5) Update any internal billing checklists or prior authorization templates to reflect these criteria. Claims submitted without prior authorization or that fail to meet approval criteria will be denied. Refer to www.humana.com/PAL for specific medical and procedural coding information for prior authorization requests.