Medicare AdvantagePrior AuthMedium impact
Hyrnuo (sevabertinib)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Sep 15, 2026
Summary
Humana Medicare Advantage has introduced a new prior authorization policy for Hyrnuo (sevabertinib), a HER2-targeted therapy for metastatic non-squamous NSCLC. Billing teams must obtain prior authorization before claims are submitted, requiring verification that patients meet four specific clinical criteria including HER2 mutation status and prior systemic therapy. This is a brand-new policy effective immediately with no transition period.
Action Required
By February 25, 2026: Billing and prior authorization teams must implement this new Humana Medicare Advantage policy requiring prior authorization for all Hyrnuo (sevabertinib) claims. Before submitting claims: (1) Verify patient meets ALL four criteria: locally advanced/metastatic non-squamous NSCLC diagnosis, documented HER2 (ERBB2) TKD activating mutations confirmed by FDA-approved test, prior systemic therapy receipt, and monotherapy use only; (2) Obtain prior authorization from Humana before dispensing; (3) Document HER2 mutation test results and prior therapy history in the patient record; (4) Contact www.humana.com/PAL for applicable coding information and preauthorization procedures. Update pharmacy billing software to flag all Hyrnuo prescriptions for mandatory prior auth review. Inform prescribers that claims will be denied without prior authorization. This policy applies only to Humana Medicare Advantage plans and does not affect Traditional Medicare or commercial coverage at this time.