Medicare AdvantagePrior AuthLow impact
Turalio® (pexidartinib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Turalio® (pexidartinib) effective December 17, 2025. The policy maintains coverage for symptomatic tenosynovial giant cell tumor (TGCT) with four strict approval criteria: confirmed diagnosis, severe morbidity/functional limitations, disease not amenable to surgery, and monotherapy use only. Prior authorization is required with 6-month initial and renewal approval periods.
Action Required
Before December 17, 2025: Billing and prior authorization staff must verify this is the current version at humana.com/PAL and update internal policy references. When processing Turalio (pexidartinib) requests for Medicare Advantage members, ensure all four approval criteria are documented by the treating provider before submitting prior authorization. Set internal tracking for 6-month approval expiration to initiate renewal requests. No workflow changes are required if prior authorization processes were already in place for this drug. Claims submitted without meeting all four criteria will be denied.