Vemlidy® (tenofovir alafenamide) (Revised)

By August 7, 2024: Billing and clinical teams must review and implement the revised Vemlidy prior authorization requirements. Specifically: (1) Update billing system rules to require prior authorization for all Vemlidy (tenofovir alafenamide) claims on commercial plans; (2) Ensure clinical documentation templates capture all three approval criteria before submission—diagnosis of chronic hepatitis B, verification of compensated liver disease status (Child-Pugh classification A or B), and documented evidence of prior therapy/contraindication/intolerance with BOTH tenofovir disoproxil fumarate AND entecavir; (3) Train billing staff and providers that claims missing any of the three criteria will be denied; (4) Verify the current policy version on Humana's TAD portal (http://apps.humana.com/tad/tad_new/home.aspx) before processing any Vemlidy authorizations to confirm no further updates have occurred. Do not rely on printed copies. Failure to obtain prior authorization or submit incomplete documentation will result in claim denials.