Medicare AdvantagePrior AuthMedium impact
Azedra® (iobenguane I 131) (Revised)
Humana·VA · Oncology, Nuclear Medicine, Radiation Oncology·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Azedra (iobenguane I 131) prior authorization policy for Medicaid and Medicare in Virginia, effective December 17, 2025. The policy maintains requirements for prior authorization before dispensing this radioactive therapeutic agent for unresectable/metastatic pheochromocytoma and paraganglioma, requiring documentation of positive iobenguane scan, patient age ≥12 years, prior inorganic iodine administration, and absence of contraindicated medications or severe renal impairment. No substantive coverage criteria changes are documented, but the revision date indicates a recent policy review that may include updated clinical references or administrative language.
Action Required
By December 17, 2025: Prior authorization team must verify that the billing system reflects current Azedra coverage requirements for Virginia Medicaid and Medicare Advantage members. Confirm that prior auth requests for Azedra therapy capture all four approval criteria: (1) diagnosis of unresectable/locally advanced/metastatic pheochromocytoma or paraganglioma, (2) positive iobenguane scan imaging documentation, (3) patient age ≥12 years, and (4) prior inorganic iodine administration. Verify system flags for exclusions: concomitant drugs reducing catecholamine uptake/depleting stores, and creatinine clearance <30 mL/min. Update provider communication materials to reference the revised December 17, 2025 policy date. Pharmacy team should not process Azedra claims without completed prior authorization. Reference the full 3-page policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a470688 for complete clinical and administrative requirements.