Medicare AdvantagePrior AuthMedium impact
Veltassa (patiromer) (Revised)
Humana·Nephrology, Cardiology, Internal Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Veltassa (patiromer) for hyperkalemia treatment, with six specific criteria including age requirements and previous medication trials. The policy includes mandatory requirements for previous treatment with or contraindication to Lokelma before approval.
Action Required
By January 1, 2025: Providers must obtain prior authorization for all Veltassa (patiromer) prescriptions for Medicare Advantage patients. Ensure documentation includes: patient age 12+, hyperkalemia diagnosis, NSAID discontinuation status, ACE inhibitor/ARB/aldosterone antagonist status, diuretic therapy details, and previous Lokelma treatment/contraindication. Update EMR templates to capture all six required criteria before prescribing.