Medicare AdvantagePrior AuthMedium impact
Tarpeyo™ (budesonide) delayed-release capsules (Revised)
Humana·Nephrology, Internal Medicine·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Tarpeyo (budesonide) delayed-release capsules for primary IgA nephropathy treatment, effective March 25, 2026. The policy requires two approval criteria: confirmed IgAN diagnosis by biopsy and use to reduce kidney function loss in patients at risk for disease progression. Billing teams must ensure all Tarpeyo claims include prior authorization before submission to avoid denials.
Action Required
By March 25, 2026: Billing team must update prior authorization workflows to require approval before processing any Tarpeyo (budesonide) delayed-release capsule claims. Verify that all prescriptions include documentation of: (1) confirmed IgAN diagnosis by biopsy, and (2) clinical indication that Tarpeyo is being used to reduce kidney function loss in patients at risk for disease progression. Flag prescriptions lacking either criterion for rejection before claim submission. Train providers and front desk staff to route all Tarpeyo requests through the prior authorization process via Humana's PAL system (www.humana.com/PAL). Claims submitted without prior authorization will be denied. Note the 9-month recommended therapy duration in clinical records to monitor for renewal limitations, as safety and efficacy beyond initial course have not been established.