Medicare AdvantagePrior AuthMedium impact
Lonsurf® (trifluridine and tipiracil) (Revised)
Humana·Oncology, Pharmacy·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Lonsurf (trifluridine/tipiracil) prior authorization policy effective December 17, 2025. This is a pharmacy prior authorization policy for Medicare Advantage members with metastatic colorectal cancer or gastric/gastroesophageal junction adenocarcinoma. The policy maintains existing approval criteria (6-month initial and renewal periods) but has been formally reviewed and updated as of the revision date.
Action Required
By December 17, 2025: Billing and pharmacy teams must ensure all Lonsurf prior authorization requests for Medicare Advantage members comply with updated criteria. For metastatic colorectal cancer: verify member has progressed, shown intolerance, or has contraindication to fluoropyrimidine, oxaliplatin, and irinotecan-based chemotherapy, PLUS anti-VEGF therapy if appropriate, PLUS anti-EGFR therapy if RAS wild-type. For gastric/gastroesophageal junction cancer: verify progression on/after two prior lines of therapy including fluoropyrimidine, platinum, taxane or irinotecan, and HER2/neu-targeted therapy if appropriate. Confirm Lonsurf is being used as monotherapy (colorectal) or as single agent (gastric), or in combination with bevacizumab (colorectal only). Verify member has NOT progressed while on prior Lonsurf therapy (automatic exclusion). Update prior authorization submission templates and pharmacy decision support systems to reflect these specific criteria. Communicate revised requirements to all ordering providers. Claims submitted without proper prior authorization or documentation of meeting all criteria will be denied.