Medicare AdvantagePrior AuthMedium impact
Felbatol® (felbamate) (New)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Felbatol (felbamate) prescriptions for Lennox-Gastaut Syndrome and partial-onset seizures. Providers must meet specific clinical criteria including specialist consultation, failed trials of other medications, and normal liver function tests.
Action Required
By January 1, 2026: Update prior authorization workflow for felbamate (Felbatol) prescriptions. Ensure neurologists and epileptologists document: 1) Diagnosis of Lennox-Gastaut Syndrome or partial-onset seizures, 2) Provider attestation of severe epilepsy justifying aplastic anemia risk, 3) Normal baseline AST/ALT results, 4) Documentation of failed trials with at least two other antiepileptic drugs. Claims without prior authorization will be denied.