Medicare AdvantagePrior AuthMedium impact
Gilotrif (afatinib) (Revised)
Humana·Oncology, Pulmonology·Medicare Advantage
We identified it
Sep 15, 2026
Summary
Humana Medicare Advantage updated its Gilotrif (afatinib) prior authorization policy on October 22, 2025. The policy maintains strict approval criteria requiring metastatic NSCLC diagnosis with documented non-resistant EGFR mutation (sensitizing types) OR squamous cell histology after platinum chemotherapy progression, with monotherapy-only use. Initial and renewal approval periods remain 6 months each. This is a routine policy revision with no material changes to coverage criteria.
Action Required
Immediately: Billing and prior authorization teams must verify they are using the October 22, 2025 version of the Humana Gilotrif (afatinib) policy (not any older version). Before submitting prior authorization requests for afatinib in Medicare Advantage members: (1) Confirm member has metastatic NSCLC diagnosis documented in medical record; (2) Obtain evidence of sensitizing EGFR mutation testing (exon 19 deletion, L861Q, S768I, G719X, or L858R) OR document squamous cell histology with prior platinum chemotherapy progression; (3) Verify afatinib is prescribed as monotherapy only (no concurrent chemotherapy); (4) Submit prior authorization with 6-month approval duration request. Update internal policy files and staff training materials to reference the revised October 22, 2025 version available at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5ce012. Failure to obtain prior authorization will result in claim denials for Medicare Advantage members.