Medicare AdvantagePrior AuthMedium impact
Velsipity (etrasimod) (Revised)
Humana·Gastroenterology, Internal Medicine, Family Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Velsipity (etrasimod) tablets for ulcerative colitis treatment. Patients must be 18+ with moderately to severely active UC and have failed or been intolerant to two specific preferred treatments including adalimumab, ustekinumab, Skyrizi, Rinvoq, or Tremfya.
Action Required
By January 1, 2025: Billing team must ensure prior authorization is obtained before prescribing Velsipity (etrasimod) for Medicare Advantage patients with ulcerative colitis. Providers must document patient age 18+, moderately to severely active UC diagnosis, and previous treatment failure/contraindication/intolerance with two of the listed preferred medications. Update EMR templates to include required criteria checklist. Claims will be denied without proper prior authorization.