Medicare AdvantagePrior AuthMedium impact
Vowst (fecal microbiota spores, live-brpk) (Revised)
Humana·Gastroenterology, Infectious Disease, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has implemented a new Prior Authorization requirement for Vowst (fecal microbiota spores, live-brpk), effective January 1, 2025. The policy requires prior authorization for this medication when used to prevent recurrent Clostridioides difficile infection (CDI), with three specific clinical criteria that must be met: prior CDI episode, completion of standard CDI treatment (vancomycin or fidaxomicin), and bowel cleanse preparation. This is a pharmacy coverage policy requiring approval before dispensing.
Action Required
By January 1, 2025: Billing and pharmacy teams must implement prior authorization workflow for Vowst prescriptions under Humana Medicare Advantage plans. Providers must verify the three clinical criteria before submitting requests: (1) documented prior CDI episode, (2) completed standard CDI treatment within 2-4 days before Vowst initiation, and (3) planned bowel cleanse with magnesium citrate or polyethylene glycol. Update billing system and pharmacy management software to flag Vowst prescriptions for mandatory prior authorization. Inform prescribers that claims will be denied if prior authorization is not obtained before dispensing. Direct questions to Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for specific coding and submission requirements.