Medicare AdvantagePrior AuthLow impact
Ekterly® (sebetralstat) (New)
Humana·Allergy & Immunology, Pharmacy·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Ekterly (sebetralstat), a new medication for treating acute hereditary angioedema attacks. The policy requires extensive diagnostic documentation and trial/failure of generic icatibant before approval.
Action Required
By August 27, 2025: Billing team must update prior authorization processes for Ekterly (sebetralstat) prescriptions for Medicare Advantage patients. Providers treating hereditary angioedema must ensure documentation includes C4 levels, C1 inhibitor levels, C1q levels, evidence of generic icatibant trial/failure, and specialist treatment confirmation before submitting prior auth requests. Claims will be denied without proper prior authorization.