Medicare AdvantagePrior AuthMedium impact
Lupkynis® (voclosporin) (Revised)
Humana·Nephrology, Rheumatology, Internal Medicine·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Lupkynis (voclosporin) prior authorization policy on February 25, 2026. The policy establishes four mandatory criteria for coverage: biopsy-proven class III/IV/V lupus nephritis, combination use with background immunosuppressive therapy, prohibition of concurrent cyclophosphamide use, and prescriber requirement for rheumatology/nephrology expertise. Prior authorization is required for all Lupkynis prescriptions with approval issued in plan year durations.
Action Required
By February 25, 2026: Billing team must implement prior authorization requirements for all Lupkynis (voclosporin) prescriptions in the billing system for Humana Medicare Advantage members. Create a PA checklist requiring verification of: (1) biopsy-proven lupus nephritis class III/IV/V diagnosis, (2) concurrent background immunosuppressive therapy documentation, (3) confirmation that cyclophosphamide is NOT being used concurrently, and (4) prescriber credentials confirming rheumatology or nephrology specialty. Before submitting claims, obtain prior authorization from Humana or claims will be denied. Update encounter templates to alert providers to document the specialist consultation and medication combination details. Train front desk and billing staff to flag Lupkynis requests for PA processing before claim submission.