Medicare AdvantagePrior AuthMedium impact
Epoprostenol Products (New)
Humana·Cardiology, Pulmonology, Critical Care·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing a new prior authorization policy for epoprostenol products (Veletri and generic) used to treat pulmonary arterial hypertension. The policy requires documentation of WHO Group I PAH confirmed by right heart catheterization, functional class II-IV status, failed maximal treatment, and other specific criteria before approval.
Action Required
Before January 1, 2026: Billing and clinical teams must implement prior authorization requirements for all epoprostenol products (Veletri and generic) for Medicare Advantage patients. Update EMR templates to document WHO Group I PAH diagnosis confirmed by right heart catheterization, WHO Functional Class II-IV status, failure of maximal medical/surgical treatment, significant symptoms, and calcium channel blocker trial/consideration. Front desk staff must verify prior auth approval before administering these medications. Claims without prior authorization will be denied.