Medicare AdvantagePrior AuthMedium impact
Voydeya™ (danicopan) tablet (Revised)
Humana·Hematology, Internal Medicine·Medicare Advantage
Effective date
Sep 25, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has issued a revised prior authorization policy for Voydeya (danicopan) tablet, effective immediately (revised July 23, 2025). This is a pharmacy coverage policy requiring prior auth for danicopan use as add-on therapy to eculizumab or ravulizumab in PNH patients with clinically significant extravascular hemolysis. Billing teams must ensure all Voydeya claims include documentation of PNH diagnosis, concurrent C5 inhibitor use, and specific hemoglobin/reticulocyte count criteria before submission.
Action Required
By August 6, 2025 (before next review date): Billing and authorization teams must implement prior authorization requirements for all Voydeya (danicopan) claims under Medicare Advantage plans. Update claim submission workflows to require documentation of: (1) PNH diagnosis confirmed by hematologist or PNH specialist, (2) concurrent eculizumab or ravulizumab therapy, (3) hemoglobin ≤9.5 g/dL AND absolute reticulocyte count ≥120 × 10⁹/L. Flag and deny any claims for monotherapy or add-on therapy to other complement inhibitors (e.g., crovalimab). Train providers and billing staff that danicopan cannot be used as monotherapy or with non-approved C5 inhibitors. Update prior auth templates and EMR documentation requirements. Coordinate with pharmacy benefits team. Claims submitted without meeting all four initial criteria or renewal criteria will be denied by Humana.