Medicare AdvantagePrior AuthMedium impact
Portrazza (necitumumab) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana has revised its Portrazza (necitumumab) prior authorization policy for Medicare Advantage members with metastatic squamous non-small cell lung cancer. The policy maintains first-line treatment coverage in combination with gemcitabine and cisplatin, but includes a critical clinical note that Portrazza has been removed from NCCN guidelines and carries Black Box Warnings for cardiopulmonary arrest and hypomagnesemia. Billing teams must ensure prior authorization is obtained before claims submission and verify member eligibility against the three coverage criteria.
Action Required
Immediately: Billing and prior authorization teams must verify that all Portrazza (necitumumab/J9301) claims for Medicare Advantage members include documented prior authorization before submission. Ensure claims meet all three criteria: (1) diagnosis of metastatic squamous NSCLC, (2) combination use with gemcitabine and cisplatin, and (3) first-line treatment status. Verify member has not experienced disease progression on Portrazza, as this is an approval exclusion. Update claim submission workflows to flag Portrazza requests that do not include valid prior authorization. Inform oncology providers that NCCN guidelines no longer recommend Portrazza; discuss with medical directors regarding potential impact on future coverage. Access preauthorization requirements at www.humana.com/PAL using the updated policy dated November 26, 2025. Claims submitted without valid prior authorization will be denied.