Medicare AdvantagePrior AuthMedium impact
Fotivda (tivozanib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Fotivda (tivozanib) prior authorization policy for Medicare Advantage members with relapsed or refractory advanced renal cell carcinoma. The policy requires prior authorization and confirms coverage criteria: diagnosis of advanced RCC, two prior systemic therapies, and use as a single agent. A new exclusion criterion denies approval if disease progression occurs on Fotivda. This is a revision to an existing policy (originally effective May 19, 2021) with the most recent update on December 17, 2025.
Action Required
By December 31, 2025: Billing team must update prior authorization workflows to incorporate the revised Fotivda coverage criteria in the billing system. (1) Verify all Fotivda prior authorization requests include documentation of: diagnosis of relapsed/refractory advanced RCC, evidence of two prior systemic therapies (immuno-oncology checkpoint inhibitors, cabozantinib, axitinib, or equivalent), and confirmation of single-agent use. (2) Add a new denial criterion to the system: deny approval if clinical documentation shows disease progression on Fotivda therapy. (3) Route all Fotivda PA requests through the oncology/medical director review team. (4) Update PA request templates and provider communication materials to reflect the December 17, 2025 revision date. (5) Train billing and prior auth staff on the new exclusion criterion. Failure to implement these changes will result in incorrect approvals and potential claim denials for non-compliant requests. Contact Humana's PAL system (www.humana.com/PAL) for current medical and procedural coding requirements.