Medicare AdvantagePrior AuthMedium impact
Lumakras (sotorasib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Sep 15, 2026
Summary
Humana Medicare Advantage revised its Lumakras (sotorasib) prior authorization policy effective January 1, 2026, with updates finalized February 25, 2026. The policy covers two distinct indications: NSCLC with KRAS G12C mutation (as monotherapy after one prior therapy) and metastatic colorectal cancer with KRAS G12C mutation (in combination with panitumumab). Both approvals are limited to 6-month initial authorization periods and require documented genetic testing confirmation.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization requirements for all Lumakras (sotorasib) claims under Humana Medicare Advantage plans. (1) Update billing system to flag Lumakras requests for prior auth review before claim submission. (2) Create or update internal approval workflow to verify: for NSCLC—documented KRAS G12C mutation, FDA-approved genetic test results, one prior therapy failure, and monotherapy use only; for mCRC—documented KRAS G12C mutation, prior fluoropyrimidine/oxaliplatin/irinotecan chemotherapy, and panitumumab co-administration. (3) Deny any requests if member has prior progression on another KRAS G12C inhibitor (sotorasib or adagrasib). (4) Establish 6-month reauthorization tracking in system to manage approval duration limits. (5) Train providers and billing staff on new criteria and exclusions. Failure to obtain prior authorization will result in claim denials. Update claim submission templates and encounter forms to remind providers of genetic testing documentation requirements.