Medicare AdvantagePrior AuthMedium impact
Yulithira (everolimus) (New)
Humana·Oncology, Nephrology, Pediatrics·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
Humana has implemented a new prior authorization policy for Yulithira (everolimus) effective July 22, 2026, covering five oncologic and non-oncologic indications. All requests require documentation of intolerance or contraindication to generic everolimus AND meeting specific clinical criteria. Members with prior disease progression on everolimus are excluded from coverage across all indications.
Action Required
By July 22, 2026: Billing and clinical teams must implement prior authorization requirements for all Yulithira (everolimus) prescriptions. Update billing software to flag all Yulithira claims as requiring prior authorization before submission. Providers must document: (1) patient intolerance or contraindication to generic everolimus, (2) specific diagnosis matching one of five covered indications (advanced RCC, neuroendocrine tumors, SEGA with TSC, angiomyolipoma with TSC, or HR+/HER2- metastatic breast cancer), and (3) applicable clinical criteria per indication. Front desk and pre-authorization staff must screen charts for prior disease progression on everolimus and flag as non-approvable. Route all requests through Humana's PAL system at www.humana.com/PAL. Claims submitted without prior authorization or missing required documentation will be denied. Verify this is the current policy version before processing claims, as Humana updates policies regularly online.