Medicare AdvantagePrior AuthMedium impact
Ventavis® (iloprost) (Revised)
Humana·Pulmonology, Cardiology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Ventavis (iloprost) for pulmonary arterial hypertension, with specific step therapy requirements including prior use of PDE-5 inhibitors or Adempas, endothelin receptor antagonists, and either Tyvaso DPI or Uptravi before approval.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for Ventavis (iloprost) nebulization solution for Humana Medicare Advantage members. Ensure providers document WHO Group I PAH diagnosis confirmed by right heart catheterization, WHO/NYHA Function Class III-IV symptoms or prior therapy failures with required medications (PDE-5 inhibitors/Adempas AND endothelin receptor antagonists AND Tyvaso DPI/Uptravi), and obtain prior authorization before prescribing. Claims will be denied without proper prior authorization.