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HumanaMedicare Advantage · Prior Auth · Medicare Advantage · Gastroenterology, Infectious Disease, Internal Medicine +1 moreMedium impact

Epclusa® (sofosbuvir/velpatasvir) (Revised)

Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
Jun 24, 2026

Summary

Humana Medicare Advantage has updated its prior authorization policy for Epclusa (sofosbuvir/velpatasvir), a hepatitis C medication. The policy requires prior authorization for chronic hepatitis C diagnosis and approves treatment for 12 weeks based on AASLD guidelines.

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What to do

by Jan 1, 2025 · 4 steps
01Billing team must obtain prior authorization before prescribing Epclusa (sofosbuvir/velpatasvir) tablets or oral pellets for Medicare Advantage patients.
02Verify patient has chronic hepatitis C diagnosis documented.
03Submit requests through Humana's portal at www.humana.com/PAL.
04Claims without prior authorization will be denied.

Original notice

Epclusa® (sofosbuvir/velpatasvir) (Revised)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Epclusa® (sofosbuvir/velpatasvir) (New)MediumEffective Jan 1, 2027 · Medicare AdvantageBrowse every Humana change in the policy list

Related policy hubs

Humana policiesGastroenterologyInfectious DiseaseInternal MedicineFamily Medicine

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