Medicare AdvantagePrior AuthMedium impact
Krazati (adagrasib) (Revised)
Humana·Oncology·Medicare Advantage
We identified it
Sep 15, 2026
Summary
Humana Medicare Advantage updated its Krazati (adagrasib) prior authorization policy on February 25, 2026. The policy maintains existing coverage criteria for two indications: NSCLC with KRAS G12C mutation (as monotherapy after ≥1 prior therapy) and metastatic CRC with KRAS G12C mutation (in combination with cetuximab after prior chemotherapy). Both approvals require prior authorization with initial and renewal periods of 6 months each. No changes to coverage criteria are evident, but the revision date confirms this is the most current guidance for Medicare Advantage members.
Action Required
Immediately: Billing and authorization teams must verify they are using the February 25, 2026 version of this policy (not older versions). When processing Krazati requests: (1) Confirm diagnosis is locally advanced or metastatic NSCLC or CRC with documented KRAS G12C mutation; (2) Verify prior therapy requirements are met (≥1 prior systemic therapy for NSCLC; fluoropyrimidine, oxaliplatin, and irinotecan for CRC); (3) Confirm appropriate use (monotherapy for NSCLC OR combination with cetuximab for CRC); (4) Screen for exclusion criteria (no prior progression on KRAS G12C inhibitors); (5) Submit prior authorization request with 6-month initial approval period and plan for 6-month renewal. Update internal policy files and training materials to reflect the revision date of 2/25/2026. Reference the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5ce00a) when submitting requests to ensure alignment with current requirements.