CommercialPrior AuthMedium impact
Auryxia (ferric citrate) (Revised)
Humana·Nephrology, Pharmacy, Internal Medicine·Commercial
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana revised its Auryxia (ferric citrate) prior authorization policy, effective January 1, 2021, with updates finalized March 22, 2023. The policy maintains two distinct approval pathways: (1) for hyperphosphatemia in dialysis patients requiring prior treatment failure/intolerance with calcium acetate AND sevelamer carbonate, and (2) for iron deficiency anemia in non-dialysis CKD patients. Both indications require prior authorization before coverage. The policy emphasizes iron parameter monitoring and contraindication screening for hemochromatosis.
Action Required
Before processing any Auryxia claims: (1) Billing and prior authorization teams must verify all Humana commercial plan requests include documentation of prior treatment failure or contraindication with BOTH calcium acetate (tablet or capsule) AND sevelamer carbonate for dialysis patients; (2) For non-dialysis CKD patients with iron deficiency anemia, confirm diagnosis and non-dialysis status are documented; (3) Providers and clinical staff must request prior authorization BEFORE dispensing—claims will be denied without pre-approval; (4) Flag any requests for patients with hemochromatosis or iron overload syndrome for medical director review; (5) Verify current policy version at http://apps.humana.com/tad/tad_new/home.aspx before submission, as printed versions become uncontrolled; (6) Update internal prior auth checklist to include iron parameter monitoring requirement (serum ferritin and transferrin levels). Failure to obtain prior authorization will result in claim denials and patient financial liability.