Medicare AdvantagePrior AuthMedium impact
Orladeyo (berotralstat) (Revised)
Humana·Allergy & Immunology·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Orladeyo (berotralstat) for hereditary angioedema prophylaxis, effective January 1, 2025. The policy now requires trial or contraindication to Haegarda as step therapy, plus specific lab documentation including C1q levels and specialist treatment requirements.
Action Required
Immediately: Update prior authorization protocols for Orladeyo (berotralstat) prescriptions. Ensure providers document all 8 criteria including HAE diagnosis with lab values (C4, C1INH levels, C1q), previous Haegarda trial/contraindication, and specialist treatment by allergist/immunologist. Train staff to collect comprehensive lab reports and treatment history before submitting PA requests to avoid denials.