Medicare AdvantagePrior AuthMedium impact
Letairis® (ambrisentan) (Revised)
Humana·Pulmonology, Internal Medicine, Cardiology·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Letairis (ambrisentan) prior authorization policy effective January 1, 2021, with the most recent revision dated October 22, 2025. The policy maintains PA requirements for PAH treatment, requiring confirmation of WHO Group I PAH diagnosis via right heart catheterization, and mandates previous treatment/intolerance/contraindication documentation for brand requests. Idiopathic pulmonary fibrosis is excluded from coverage.
Action Required
By November 15, 2025: Billing and clinical teams must ensure all Letairis/ambrisentan requests include prior authorization submission to Humana Medicare Advantage plans. Requirements: (1) Verify member has WHO Group I PAH diagnosis confirmed by right heart catheterization documentation in medical record; (2) For brand Letairis requests, confirm and document member's previous treatment with generic ambrisentan, intolerance, or contraindication; (3) Screen for idiopathic pulmonary fibrosis diagnosis—if present, do not submit for approval as exclusion applies. Update EMR templates and prior authorization checklists to include these verification steps. Implement in billing system workflow to flag incomplete documentation before submission. Failure to meet criteria will result in claim denials. Route all PA requests through www.humana.com/PAL for Medicare Advantage members.