Medicare AdvantagePrior AuthLow impact
Banzel® (rufinamide) (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented prior authorization requirements for Banzel (rufinamide) prescriptions effective January 1, 2026. The medication requires pre-approval for Lennox-Gastaut Syndrome treatment and must meet specific criteria including combination therapy and prior treatment failure.
Action Required
By January 1, 2026: Providers prescribing Banzel (rufinamide) for Humana Medicare Advantage patients must obtain prior authorization before dispensing. Document diagnosis of Lennox-Gastaut Syndrome, planned combination therapy, and previous treatment failures. Update pharmacy coverage policies and inform providers that claims will be denied without prior approval.