Medicare AdvantagePrior AuthMedium impact
Cuvrior™ (trientine tetrahydrochloride) (Revised)
Humana·Internal Medicine, Gastroenterology, Genetics·Medicare Advantage
Effective date
May 24, 2023
We identified it
Jun 25, 2026
Summary
This is a revision to Humana's Cuvrior (trientine tetrahydrochloride) prior authorization policy for Medicare Advantage members with Wilson's disease. The policy requires prior authorization and confirms three mandatory clinical criteria: confirmed Wilson's disease diagnosis, completion of initial copper removal therapy, and demonstrated tolerance to penicillamine. The revision date of December 17, 2025 indicates recent updates to this rare disease medication coverage.
Action Required
Immediate: Billing team must implement prior authorization requirement for all Cuvrior (trientine tetrahydrochloride) prescriptions for Medicare Advantage members. Before submitting claims, verify that providers have documented all three clinical criteria in the patient record: (1) confirmed Wilson's disease diagnosis with supporting evidence (Kayser-Fleischer rings + low ceruloplasmin + elevated 24-hour urinary copper, OR molecular genetic confirmation, OR liver biopsy confirmation), (2) completion of initial chelator therapy (de-coppered status), and (3) patient tolerance to penicillamine. Submit prior authorization requests through www.humana.com/PAL using the Preauthorization and Notification List. Flag any claims lacking complete clinical documentation and return to provider for additional information before processing. Claims submitted without prior authorization will be denied.