Medicare AdvantagePrior AuthMedium impact
Hyrnuo (sevabertinib)
Humana·Oncology·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jul 1, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Hyrnuo (sevabertinib) when treating locally advanced or metastatic non-squamous NSCLC with HER2 TKD activating mutations in patients who have received prior systemic therapy. The medication must be prescribed as monotherapy to qualify for coverage. This is a new pharmacy policy effective February 25, 2026.
Action Required
By February 25, 2026: Billing and clinical teams must implement prior authorization requirements for Hyrnuo (sevabertinib) in the billing system and clinical workflows. (1) Oncology providers must verify all four coverage criteria before prescribing: locally advanced/metastatic non-squamous NSCLC diagnosis, documented HER2 TKD activating mutation, prior systemic therapy receipt, and monotherapy use. (2) Billing team must route all Hyrnuo claims through prior authorization process via Humana's PAL system (www.humana.com/PAL) before dispensing. (3) Update pharmacy system and prior auth templates to require HER2 mutation documentation (FDA-approved test result) and chemotherapy history. (4) Alert oncology providers and infusion centers that claims will be denied without approved prior authorization. (5) Flag any requests for combination therapy or first-line use as non-covered and route for denial per policy.