Medicare AdvantagePrior AuthMedium impact
FILSPARI® (sparsentan) (Revised)
Humana·Nephrology, Internal Medicine, Pharmacy·Medicare Advantage
Effective date
Aug 23, 2023
We identified it
Jun 25, 2026
Summary
Humana has updated its prior authorization policy for FILSPARI® (sparsentan) effective August 23, 2023, with a recent revision on October 22, 2025. This is a pharmacy coverage policy for Medicare Advantage members with primary immunoglobulin A nephropathy (IgAN) requiring prior authorization before dispensing. Key requirements include confirmation of IgAN diagnosis by biopsy, failure or intolerance of ACEi/ARB therapy, minimum eGFR ≥30 mL/min/1.73 m², discontinuation of conflicting medications (RAS inhibitors, endothelin receptor antagonists, aliskiren), mandatory liver function monitoring every 3 months, and pregnancy testing/contraception protocols.
Action Required
By October 22, 2025 (or immediately upon implementation): (1) Pharmacy/Billing Team: Update pharmacy billing system and prior authorization workflows to require PA submission for all FILSPARI (sparsentan) claims on Medicare Advantage plans. (2) Prior Auth Reviewers: Establish PA review criteria checklist confirming: IgAN biopsy confirmation (Criteria #1), disease progression indication (Criteria #2), documented ACEi/ARB trial failure or contraindication (Criteria #3), eGFR ≥30 documented (Criteria #4), and confirmation that RAS inhibitors/endothelin antagonists/aliskiren will be discontinued (Criteria #5). (3) Provider Relations: Distribute updated policy requirements to all prescribing nephrologists and primary care providers. Emphasize medication discontinuation requirement before FILSPARI initiation and mandatory liver function test monitoring (baseline and every 3 months). (4) Compliance: Flag that FILSPARI is restricted to REMS program only—verify patient enrollment in FILSPARI REMS before claim processing. (5) Claims Team: Deny claims lacking documented prior authorization approval. Note: Approval duration is plan year or clinical review basis—set system to track renewal requirements annually. Consequence of non-compliance: Claims will be denied without proper PA documentation meeting all five criteria.