Medicare AdvantagePrior AuthMedium impact
Equetro® (carbamazepine) (Revised)
Humana·Neurology, Psychiatry, Pain Management·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Equetro® (carbamazepine) extended-release pharmacy coverage policy with a revision date of February 25, 2026. The policy maintains prior authorization requirements for three indications: seizures (requiring failure of generic carbamazepine plus one other antiepileptic agent), acute manic/mixed bipolar I episodes (requiring prior generic carbamazepine treatment), and trigeminal neuralgia (requiring prior generic carbamazepine treatment). All approvals are valid for the plan year with renewal at plan year duration.
Action Required
Immediately: Billing and prior authorization teams must verify this is the current active policy in their system (revision date 2/25/2026). For any pending or new Equetro® authorization requests for Medicare Advantage members, confirm: (1) For seizure claims—member has documented failure with generic carbamazepine AND at least one other seizure medication (levetiracetam, topiramate, gabapentin, divalproex, or lamotrigine); (2) For bipolar disorder or trigeminal neuralgia claims—member has prior treatment history with generic carbamazepine formulation. All Equetro® prescriptions require prior authorization before dispensing. Update internal policy documentation and staff training materials to reflect the 2/25/2026 revision. Do not rely on printed versions of this policy. Reference the online version at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a4cad51 before processing authorizations.