Medicare AdvantagePrior AuthMedium impact
Felbatol® (felbamate) (New)
Humana·Neurology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Felbatol (felbamate) effective January 1, 2026 for Medicare Advantage plans. Requires specialist prescription and documentation that patient has failed at least two other seizure medications before approval.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for all Felbatol (felbamate) prescriptions for Medicare Advantage patients. Ensure providers document: 1) specialist consultation, 2) normal baseline liver enzymes (AST/ALT), 3) failure of at least two other seizure medications, and 4) patient acknowledgment of aplastic anemia risk. Claims will be denied without proper prior authorization.