Medicare AdvantagePrior AuthMedium impact
Xromi oral solution (Revised)
Humana·Hematology, Pediatrics, Pharmacy·Medicare Advantage
Effective date
Apr 23, 2025
We identified it
Jun 25, 2026
Summary
Humana has updated its prior authorization policy for Xromi oral solution (hydroxyurea) effective April 23, 2025. This is a revised Medicare Advantage pharmacy policy requiring prior authorization for sickle cell anemia treatment. The policy requires members to have a diagnosis of sickle cell anemia with recurrent moderate to severe pain crises AND prior treatment or intolerance with hydroxyurea capsule before approval.
Action Required
By April 23, 2025: Billing team must implement prior authorization requirements for Xromi oral solution claims submitted to Humana Medicare Advantage plans. Update billing system to flag all Xromi prescriptions for prior authorization. Verify that pharmacy systems cross-reference the two approval criteria: (1) diagnosis of sickle cell anemia with recurrent moderate to severe pain crises, AND (2) documented previous treatment or intolerance with hydroxyurea capsule. Provider offices should educate prescribers that claims will be denied without prior auth and must include documentation of prior hydroxyurea exposure. Coordinate with prescribing physicians to gather required clinical documentation before submission. Note: This policy applies only to Humana Medicare Advantage members, not Traditional Medicare or commercial plans.