Medicare AdvantagePrior AuthMedium impact
Epclusa® (sofosbuvir/velpatasvir) (Revised)
Humana·Gastroenterology, Infectious Disease, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
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.
Action Required
By January 1, 2025: Billing team must obtain prior authorization before prescribing Epclusa (sofosbuvir/velpatasvir) tablets or oral pellets for Medicare Advantage patients. Verify patient has chronic hepatitis C diagnosis documented. Submit requests through Humana's portal at www.humana.com/PAL. Claims without prior authorization will be denied.