Medicare AdvantagePrior AuthMedium impact
Amivantamab Products (Rybrevant, Rybrevant Faspro) (Revised)
Humana·FL, KY, SC · Oncology, Pulmonology·Medicaid
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Amivantamab (Rybrevant, Rybrevant Faspro) prior authorization policy effective January 28, 2026, for Medicare and three state Medicaid programs (Florida, Kentucky, South Carolina). The policy clarifies coverage for four distinct NSCLC EGFR mutation scenarios with specific prior auth criteria; notably, Rybrevant Faspro (subcutaneous) is now explicitly differentiated from intravenous formulations with a critical warning against substitution due to different dosing and administration protocols.
Action Required
By January 28, 2026: (1) Billing team must update prior authorization workflows in the billing system to require prior auth for all Amivantamab products (Rybrevant IV and Rybrevant Faspro SC) for the applicable plan types and states. (2) Configure the system to verify one of four specific coverage pathways based on mutation type, treatment setting, and prior therapy history before claim submission. (3) Providers and clinical staff must review the critical safety note prohibiting substitution between Rybrevant (intravenous) and Rybrevant Faspro (subcutaneous) formulations — document the intended formulation on all authorization requests and encounter forms to prevent dispensing errors. (4) Update your payer contact list with Humana's Preauthorization and Notification List (available at www.humana.com/PAL) for current coding requirements. (5) Training: Ensure billing, authorization, and clinical staff understand the four distinct indications and their respective approval criteria to prevent claim denials. Failure to obtain prior authorization or submitting claims for non-covered mutation types/treatment combinations will result in denials.