Medicare AdvantagePrior AuthMedium impact
Sympazan® (clobazam oral film) (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 Sympazan (clobazam oral film) used to treat seizures associated with Lennox-Gastaut Syndrome. Approval requires documented contraindication to both generic clobazam tablet and oral suspension forms.
Action Required
By January 1, 2025: Billing team must update prior authorization workflows for Sympazan (clobazam oral film) prescriptions for Humana Medicare Advantage patients. Providers must document Lennox-Gastaut Syndrome diagnosis, combination therapy with other seizure medications, and contraindications to generic clobazam forms (tablet and oral suspension) before prescribing. Claims will be denied without proper prior authorization.