Medicare AdvantagePrior AuthLow impact
Gilotrif (afatinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its Gilotrif (afatinib) prior authorization policy effective January 1, 2020, with a revision dated October 22, 2025. The policy maintains coverage for metastatic NSCLC patients with documented non-resistant EGFR mutations OR squamous cell histology after platinum-containing chemotherapy progression, requiring prior authorization with 6-month initial and renewal periods. This is a routine policy maintenance update with no substantive coverage changes from the original effective date.
Action Required
No immediate action required. This is a policy clarification/maintenance update on a drug that has been covered since January 1, 2020. Billing team should verify current system has prior authorization requirement enabled for Gilotrif (afatinib) claims for Medicare Advantage members. Confirm that prior auth requests include documentation of: (1) metastatic NSCLC diagnosis, (2) either documented non-resistant EGFR mutation status OR squamous cell histology post-platinum chemotherapy, and (3) monotherapy use without concomitant chemotherapy. Obtain the current version directly from Humana's website before processing claims to ensure you have the most recent guidance, as printed copies become uncontrolled.