Medicare AdvantagePrior AuthLow impact
Sephience™ (sepiapterin) (New)
Humana·Pediatrics, Genetics, Endocrinology·Medicare Advantage
Effective date
Sep 24, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a new prior authorization policy for Sephience (sepiapterin), a medication for treating phenylketonuria (PKU). Prior authorization is required and patients must have tried generic sapropterin first or have a contraindication/intolerance to it.
Action Required
By September 24, 2025: Providers treating PKU patients must obtain prior authorization before prescribing Sephience (sepiapterin) for Humana Medicare Advantage members. Ensure documentation shows previous treatment with, contraindication to, or intolerance of generic sapropterin. Update EMR templates to include prior auth reminder for PKU treatments.