Medicare AdvantagePrior AuthMedium impact
Xcopri® (cenobamate) (Revised)
Humana·Neurology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Xcopri (cenobamate) prior authorization policy effective January 1, 2025, with updates finalized May 27, 2026. The policy requires prior authorization for Xcopri tablets and maintenance/titration packs for Medicare Advantage members with partial-onset seizures who have failed at least two other antiepileptic drugs. Billing teams must ensure all Xcopri claims include documented evidence of prior treatment failure before submission.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirement for all Xcopri (cenobamate) claims under Humana Medicare Advantage plans. Specifically: (1) Update billing system to flag all Xcopri prescriptions for prior auth processing before claim submission; (2) Create or update prior authorization request templates to require documentation that patient has failed treatment with at least TWO of the following antiepileptic drugs: levetiracetam, lamotrigine, carbamazepine, zonisamide, divalproex, gabapentin, or topiramate; (3) Train providers and front-desk staff to collect documented evidence of prior drug failures from patient charts before submitting prescriptions; (4) Establish verification process with neurology/epilepsy specialists to confirm prior treatment history. Failure to obtain prior authorization will result in claim denials. Reference Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for current medical coding requirements.