Medicare AdvantagePrior AuthLow impact
Fabhalta® (iptacopan) capsule (Revised)
Humana·Hematology, Nephrology, Internal Medicine·Medicare Advantage
Effective date
May 22, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for Fabhalta (iptacopan) capsules, effective May 22, 2024. This policy covers treatment for rare blood and kidney disorders including PNH, IgA nephropathy, and complement 3 glomerulopathy with specific clinical criteria that must be met for approval.
Action Required
Immediately: Billing and clinical teams must obtain prior authorization from Humana Medicare Advantage before prescribing Fabhalta (iptacopan) for patients with PNH, IgA nephropathy, or C3G. Ensure medical records document all required clinical criteria including flow cytometry results, hemolysis indicators, and specialist consultations. Claims will be denied without proper prior authorization.