Medicare AdvantagePrior AuthLow impact
Aqvesme (mitapivat) tablet (New)
Humana·Hematology, Internal Medicine·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is introducing prior authorization requirements for Aqvesme (mitapivat) tablets, a new medication for treating anemia in adults with alpha- or beta-thalassemia. This medication requires REMS enrollment and has specific approval criteria including diagnosis confirmation, baseline hemoglobin levels, and exclusions for liver cirrhosis.
Action Required
By March 25, 2026: Billing and clinical teams must be aware that Aqvesme (mitapivat) tablets for thalassemia treatment require prior authorization through Humana Medicare Advantage. Providers treating adult patients with alpha- or beta-thalassemia should obtain prior auth before prescribing, ensuring patients meet criteria including hemoglobin levels ≤10 g/dL or requiring 6-20 RBC transfusions in prior 24 weeks, and do not have liver cirrhosis. Claims will be denied without proper prior authorization.