Medicare AdvantagePrior AuthMedium impact
Rozlytrek™ (entrectinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana has revised its Rozlytrek (entrectinib) pharmacy coverage policy effective May 27, 2026. This is a prior authorization policy for Medicare Advantage members with metastatic/recurrent ROS1-positive NSCLC or metastatic solid tumors with NTRK gene fusion. The policy clarifies approval criteria and duration requirements for this targeted cancer therapy.
Action Required
By May 27, 2026: Billing and prior authorization teams must ensure all Rozlytrek (entrectinib) claims for Medicare Advantage members include prior authorization. Verify members meet BOTH criteria for their indication: (1) For NSCLC: metastatic or recurrent diagnosis AND ROS1-positive disease confirmation; (2) For solid tumors: metastatic OR not candidate for surgery AND documented NTRK fusion without resistance mutation AND disease progression or no alternatives. Update PA submission templates and billing software to enforce these specific clinical criteria checks. Route all Rozlytrek requests through the Humana PAL system (www.humana.com/PAL) for medical/procedural coding guidance. Claims submitted without proper prior authorization meeting these criteria will be denied. Providers and billing staff must verify genetic testing documentation (ROS1-positive or NTRK fusion status) is present before claim submission.