Medicare AdvantagePrior AuthMedium impact
Auryxia® (ferric citrate) (Revised)
Humana·Nephrology, Internal Medicine, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
Humana updated its Auryxia (ferric citrate) prior authorization policy for Medicare Advantage members with a revision date of February 28, 2024. The policy maintains strict prior auth requirements for hyperphosphatemia treatment in dialysis patients and clarifies that members must have failed or been intolerant to both calcium acetate AND sevelamer carbonate before approval. The policy also includes an exclusion for iron deficiency anemia treatment in non-dialysis CKD patients without additional approvable indications.
Action Required
By March 15, 2025: Billing team must verify prior authorization requirements for all Auryxia claims submitted to Humana Medicare Advantage plans. Before submitting claims, obtain documentation from providers confirming: (1) member diagnosis of hyperphosphatemia associated with CKD on dialysis, (2) member is actively on dialysis, and (3) member has documented previous treatment failure or intolerance with BOTH calcium acetate AND sevelamer carbonate. Do NOT submit claims for iron deficiency anemia treatment in non-dialysis CKD patients unless additional approvable indications are documented. Update claim denial tracking to monitor for rejections based on missing prior auth or incomplete member criteria. Contact Humana PAL system at www.humana.com/PAL for current claim code requirements. Failure to obtain prior authorization or submit complete documentation will result in claim denials.