Medicare AdvantagePrior AuthMedium impact
Odomzo® (sonidegib) (Revised)
Humana·Oncology, Dermatology·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its prior authorization policy for Odomzo® (sonidegib) for basal cell carcinoma treatment, with the revision effective April 22, 2026. The policy maintains existing approval criteria requiring locally advanced/metastatic BCC diagnosis with prior treatment failure or contraindication to surgery/radiation, and specifies 6-month initial and renewal authorization periods. Billing teams must ensure all Odomzo claims for Medicare Advantage members include prior authorization before submission.
Action Required
By April 22, 2026: Billing team must verify all Odomzo (sonidegib) prescriptions for Humana Medicare Advantage members include valid prior authorization before claim submission. Update billing system templates to flag Odomzo as requiring prior auth. Coordinate with providers to ensure they submit prior auth requests documenting: (1) diagnosis of locally advanced or metastatic basal cell carcinoma, (2) evidence of recurrence/progression after surgery or radiation OR contraindication to these treatments, and (3) no prior disease progression on Odomzo. Verify authorization duration limits (6 months initial, 6 months per renewal). Claims submitted without prior authorization or for excluded indications will be denied. Reference current policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a511d8e before processing.