Medicare AdvantagePrior AuthMedium impact
Fintepla® (fenfluramine) (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Fintepla (fenfluramine) for treating seizures in Dravet Syndrome and Lennox-Gastaut Syndrome patients age 2+. Different criteria apply: Dravet requires failure of one other drug, while Lennox-Gastaut requires failure of two other drugs, both need specialist prescription.
Action Required
By January 1, 2025: Billing team must update prior authorization system for Fintepla (fenfluramine) prescriptions for Medicare Advantage members. Ensure providers document: 1) Diagnosis of Dravet or Lennox-Gastaut syndrome seizures, 2) Prescription by neurologist/epileptologist, 3) Failure of previous treatments (1 drug for Dravet, 2 drugs for Lennox-Gastaut). Claims will be denied without proper prior authorization.