Medicare AdvantagePrior AuthMedium impact
Vigabatrin products (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for vigabatrin products (Vigadrone, Vigpoder, generic vigabatrin, Vigafyde) effective January 1, 2024, with updates as of June 24, 2026. The policy requires prior authorization for two indications: (1) Refractory Complex Partial Seizures—requiring documented failure of at least two other anticonvulsants plus concurrent use with another seizure medication, and (2) Infantile Spasms—requiring only documented diagnosis. All prescriptions must comply with the Vigabatrin REMS Program due to black box warnings regarding permanent vision loss.
Action Required
By January 1, 2024: Billing team must implement prior authorization requirements for all vigabatrin product claims (generic vigabatrin, Vigadrone, Vigpoder, Vigafyde) submitted to Humana Medicare Advantage. For complex partial seizures: verify provider documentation shows failed trials of at least TWO other anticonvulsants (e.g., levetiracetam, topiramate, carbamazepine, gabapentin, divalproex, lamotrigine) AND concurrent use with another seizure control medication before submitting claims. For infantile spasms: verify documented diagnosis only. All prior authorization requests must reference the Vigabatrin REMS Program enrollment status. Route all vigabatrin claims through the prior authorization process at www.humana.com/PAL before claim submission. Failure to obtain prior authorization will result in claim denials. Neurologists, pediatricians, and prescribing providers should be notified of these requirements. Update billing software rules to flag vigabatrin prescriptions for mandatory prior auth review. Re-verify policy requirements on or before June 17, 2026 for the next scheduled review date.