Medicare AdvantagePrior AuthMedium impact
Fycompa® (perampanel) (Revised)
Humana·Neurology, Pediatrics, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Fycompa (perampanel) effective January 1, 2023, with the most recent revision dated November 26, 2025. The policy establishes prior authorization requirements for two indications: partial-onset (focal) seizures requiring failure on at least two other antiepileptic drugs, and adjunctive treatment of generalized tonic-clonic seizures requiring combination therapy and prior failure on at least two other drugs. The policy includes a black box warning regarding serious psychiatric and behavioral adverse reactions requiring monitoring.
Action Required
By January 15, 2026: Billing team must implement prior authorization requirements for all Fycompa (perampanel) requests from Medicare Advantage members. Specifically: (1) For partial-onset seizures: verify member has diagnosis of partial-onset (focal) seizures AND has failed at least TWO other antiepileptic drugs (levetiracetam, lamotrigel, carbamazepine, zonisamide, divalproex, gabapentin, or topiramate); (2) For generalized tonic-clonic seizures: verify member has diagnosis of generalized tonic-clonic seizures AND will use Fycompa with at least one other seizure control drug AND has failed at least TWO other antiepileptic drugs (lamotrigine, topiramate, carbamazepine, gabapentin, divalproex). Update prior authorization request templates and clinical decision support in billing software to capture these criteria. Train prior auth staff and providers on the dual-indication pathway. Claims submitted without meeting these criteria or without prior authorization will be denied. Reference www.humana.com/PAL for applicable medical and procedural coding information.