CommercialPrior AuthMedium impact
Accrufer™ (ferric maltol) (Revised)
Humana·Gastroenterology, Nephrology, Hematology +2 more·Commercial
Effective date
May 22, 2024
We identified it
Jun 25, 2026
Summary
Humana has revised its Accrufer™ (ferric maltol) pharmacy coverage policy effective May 22, 2024. This is a prior authorization policy for commercial plans requiring documentation that members have iron deficiency, underlying causes have been treated, and they have failed or cannot tolerate ferrous-form oral iron products before approval. The policy applies to Accrufer capsules (30 mg iron) for iron deficiency treatment in adults.
Action Required
By May 22, 2024 (already effective): Billing and clinical teams must implement prior authorization requirements for all Accrufer™ (ferric maltol) claims on commercial plans. Update pharmacy billing system to flag Accrufer prescriptions for prior auth review. Verify members meet ALL three criteria before billing: (1) diagnosed iron deficiency, (2) underlying cause treated (e.g., GI bleed, abnormal uterine bleeding), and (3) failure or contraindication with ferrous-form iron products (ferrous sulfate, fumarate, gluconate). Attach documentation of failed ferrous trials or documented intolerance/contraindication to prior auth requests. Denial will occur without demonstrated attempt or contraindication to first-line ferrous iron products. Pharmacy staff should verify approval status before dispensing.