Medicare AdvantagePrior AuthMedium impact
Onfi® (clobazam) (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a revised prior authorization policy for Onfi (clobazam) effective January 1, 2026. The policy requires prior authorization for both brand and generic clobazam products used to treat seizures associated with Lennox-Gastaut Syndrome, with specific criteria including combination therapy and documented failure of other treatments.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for all clobazam products (brand Onfi and generic) for Humana Medicare Advantage patients. Ensure providers document: 1) Lennox-Gastaut Syndrome diagnosis, 2) combination with other seizure medications, and 3) trial and failure of at least one other adjunctive LGS treatment (lamotrigine, rufinamide, or topiramate). Update encounter forms and EMR templates to capture required criteria. Claims will be denied without proper prior authorization.