Medicare AdvantagePrior AuthMedium impact
Aptiom® (eslicarbazepine acetate) (Revised)
Humana·Neurology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Aptiom (eslicarbazepine acetate), an anti-seizure medication. The policy requires prior auth for partial-onset seizures and mandates that patients must have failed at least two other seizure medications before approval.
Action Required
Immediately: Billing team must ensure prior authorization is obtained before prescribing Aptiom (eslicarbazepine acetate) for Humana Medicare Advantage patients. Providers must document diagnosis of partial-onset seizures, confirm patient will not use with oxcarbazepine, and document failure of at least two other anti-seizure medications (levetiracetam, lamotrigine, carbamazepine, zonisamide, divalproex, gabapentin, or topiramate). Update EMR templates to include these documentation requirements. Claims will be denied without proper prior authorization.