Medicare AdvantagePrior AuthMedium impact
Truseltiq (infigratinib) (Revised)
Humana·Oncology, Hematology·Medicare Advantage
Effective date
May 22, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its Truseltiq (infigratinib) prior authorization policy on May 22, 2024, for Medicare Advantage and Commercial plans. The policy requires prior authorization for this FGFR2 inhibitor used to treat unresectable locally advanced or metastatic cholangiocarcinoma with FGFR2 fusion/rearrangement in previously treated patients. Initial approvals are limited to six-month durations, and patients with prior disease progression on FGFR2 inhibitors are excluded from coverage.
Action Required
By May 22, 2024 (or immediately if missed): Billing and clinical teams must implement prior authorization requirements for Truseltiq (infigratinib) claims. Specifically: (1) Update billing system to require prior authorization submission before claims are processed; (2) Verify patient eligibility against four criteria: unresectable locally advanced/metastatic cholangiocarcinoma with FGFR2 fusion/rearrangement confirmed by FDA-approved test, prior treatment history, and single-agent use for subsequent therapy; (3) Screen for exclusion criteria—deny approval if patient has prior disease progression on any FGFR2 inhibitor (infigratinib, pemigatinib, or others); (4) Set approval authorization to six-month durations and flag for re-authorization at month 6; (5) Update prior authorization request templates and provider communication materials to reflect these requirements. Coordinate with oncology providers to ensure they submit required documentation (FGFR2 genetic testing results, prior treatment records). Without prior authorization, claims will be denied.