CommercialPrior AuthMedium impact
Kerendia® (finerenone) (Revised)
Humana·Endocrinology, Nephrology, Internal Medicine +1 more·Commercial
Effective date
Sep 25, 2024
We identified it
Jun 25, 2026
Summary
Humana's Kerendia (finerenone) pharmacy coverage policy was revised on September 25, 2024. This is a prior authorization policy for commercial plans covering chronic kidney disease associated with type 2 diabetes. The policy requires prior authorization with four specific clinical criteria: CKD diagnosis with T2D, serum potassium ≤5.0 mEq/L, concurrent maximally tolerated ACE-I or ARB therapy, and prior treatment/contraindication/intolerance to SGLT2 inhibitors. Billing teams must ensure all Kerendia requests include documentation of these four criteria before submission to avoid claim denials.
Action Required
By October 9, 2024 (within 2 weeks of revision): Billing team and clinical staff must implement prior authorization process for all Kerendia (finerenone) tablet prescriptions for Humana commercial members. (1) Update billing system to flag all Kerendia requests for mandatory prior authorization. (2) Create internal checklist requiring documentation of all four approval criteria before PA submission: diagnosis of CKD with T2D, serum potassium level ≤5.0 mEq/L at initiation, current maximally tolerated dose of ACE-I or ARB, and prior SGLT2i treatment/contraindication/intolerance. (3) Train providers and clinical staff on these requirements and notify them that claims without prior authorization will be denied. (4) Update patient intake and medication history templates to capture SGLT2i history and current potassium levels. (5) Establish communication with Humana's prior authorization portal at http://apps.humana.com/tad/tad_new/home.aspx and verify current policy version before each submission. Failure to obtain prior authorization will result in claim denials.