Medicare AdvantagePrior AuthMedium impact
Tabrecta (capmatinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Tabrecta (capmatinib) prior authorization policy on November 26, 2025. The policy requires prior authorization for this MET exon 14 skipping inhibitor in metastatic NSCLC patients, with approval contingent on documented MET exon 14 skipping mutation and denial of further coverage upon disease progression. This is a routine policy maintenance update with no material changes to coverage criteria.
Action Required
By December 10, 2025: Billing and prior authorization staff must verify this is the current Tabrecta policy version in your system by checking Humana's online portal at www.humana.com/PAL. Update internal documentation to reflect the November 26, 2025 revision date. Ensure all Tabrecta (capmatinib) requests for Medicare Advantage members include verification of: (1) metastatic NSCLC diagnosis, (2) documented MET exon 14 skipping positive mutation via FDA-approved test, and (3) confirmation that member has not experienced disease progression on prior Tabrecta therapy. Prior authorization is required before dispensing. Claims submitted without proper prior authorization will be denied by Humana Medicare Advantage plans.