Medicare AdvantagePrior AuthMedium impact
Eliquis® (apixaban) Sprinkle & Tablet for Oral Suspension (New)
Humana·Pediatrics, Hematology, Cardiology +2 more·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has introduced a new step therapy policy for pediatric Eliquis formulations (Sprinkle capsules and tablets for oral suspension) used to treat venous thromboembolism in patients. Prior authorization is required unless the patient has previously tried standard Eliquis tablets, has contraindications/intolerance to tablets, or is 17 years or younger.
Action Required
By October 22, 2025: Billing team must update prior authorization procedures for Eliquis Sprinkle capsules and tablets for oral suspension. Ensure documentation shows either previous treatment/contraindication/intolerance with standard Eliquis tablets OR patient is 17 years or younger before prescribing these formulations. Claims without proper prior authorization will be denied.