Medicare AdvantagePrior AuthMedium impact
Vitrakvi (larotrectinib) (Revised)
Humana·Oncology·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Vitrakvi (larotrectinib) pharmacy coverage policy for Medicare Advantage members on August 27, 2025. The policy maintains prior authorization requirements for this TRK inhibitor used to treat advanced/metastatic NTRK gene fusion-positive solid tumors. Key criteria remain: confirmed NTRK gene fusion without resistance mutation, advanced/metastatic disease or surgical inoperability, and no satisfactory alternative treatment options. The revision appears to be a routine update with prescribing information current as of April 2025.
Action Required
By September 15, 2025: Prior authorization team must ensure Vitrakvi (larotrectinib) requests for Medicare Advantage members verify all three approval criteria are documented: (1) advanced/metastatic solid tumor OR surgical inoperability, (2) documented NTRK gene fusion without known resistance mutation, and (3) no alternative systemic therapy options. Update prior auth templates and provider ordering guidance to reflect current policy language. Verify that claims systems are configured to route Vitrakvi PA requests through standard Humana preauthorization channels. Oncology providers should be notified of the August 2025 revision to ensure documentation includes genetic testing confirmation and treatment history. Claims submitted without complete prior authorization will be denied.