Medicare AdvantagePrior AuthMedium impact
Kerendia® (finerenone) (Revised)
Humana·Cardiology, Endocrinology, Nephrology +1 more·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Kerendia (finerenone) prior authorization policy for Medicare Advantage plans effective November 26, 2025. The policy maintains existing approval criteria for two indications: CKD with type 2 diabetes (requiring ACE inhibitor or ARB use) and heart failure with LVEF ≥40%. Billing teams must ensure all Kerendia requests include required clinical documentation and meet specified approval criteria to avoid claim denials.
Action Required
By November 26, 2025: Billing team must ensure prior authorization processes for Kerendia (finerenone) tablets (10mg, 20mg, 40mg) include verification of: (1) For CKD/T2D indication—diagnosis of CKD with type 2 diabetes AND documentation that member is on maximally tolerated dose of ACE inhibitor or ARB; (2) For heart failure indication—diagnosis of heart failure AND LVEF ≥40%. Update authorization request templates to require these specific clinical criteria. Verify serum potassium levels (must be ≤5.0 mEq/L) and eGFR documentation are included before submission. Claims submitted without meeting these criteria or lacking required prior authorization will be denied. Coordinate with prescribing providers to ensure documentation is complete before claims are submitted.