Medicare AdvantagePrior AuthLow impact
Korsuva™ (difelikefalin) (Revised)
Humana·Nephrology, Pharmacy·Medicare Advantage
Effective date
May 27, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Korsuva™ (difelikefalin) effective May 27, 2026. The policy maintains existing coverage criteria requiring CKD-associated pruritus diagnosis and consistent hemodialysis (3+ times weekly for 3 months), with initial approval for 6 months and renewal approvals for plan year durations. This is a routine policy revision with no changes to approval criteria or billing requirements.
Action Required
By May 27, 2026: Billing team should verify current policy version in Humana's online system before processing any new Korsuva prior authorization requests. No workflow changes are required as approval criteria remain unchanged from the previous version. Ensure prior authorization requests for Korsuva include documentation of: (1) CKD-aP diagnosis, (2) consistent hemodialysis 3+ times weekly for previous 3 months, and (3) for renewals, evidence of pruritus improvement. Reference the updated policy document from https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a53ed91 to confirm this is the current version.