Medicare AdvantagePrior AuthMedium impact
Orenitram® (treprostinil) (Revised)
Humana·Cardiology, Pulmonology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Orenitram (treprostinil) for pulmonary arterial hypertension treatment, effective January 1, 2026. Members must meet specific criteria including confirmed WHO Group 1 PAH diagnosis via right heart catheterization and prior therapy/intolerance to other PAH medications before Orenitram can be approved.
Action Required
Before January 1, 2026: Billing team and providers must implement prior authorization requirements for all Orenitram (treprostinil) prescriptions for Humana Medicare Advantage patients. Ensure documentation includes WHO Group 1 PAH diagnosis confirmed by right heart catheterization, prior therapy history with PDE-5 inhibitors or riociguat, endothelin receptor antagonists, and Tyvaso DPI or Uptravi. Update EMR templates to capture required criteria. Claims will be denied without proper prior authorization.