Medicare AdvantagePrior AuthMedium impact
Firdapse® (amifampridine) (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Firdapse® (amifampridine) prior authorization policy on October 22, 2025. The policy maintains existing coverage requirements for Lambert-Eaton Myasthenic Syndrome (LEMS) treatment: specialist confirmation of diagnosis, clinical evaluation support (electromyography or VGCC auto-antibodies), and absolute exclusion for patients with seizure history. No substantive coverage changes are documented, but the recent revision requires verification that this is the current active policy before processing claims.
Action Required
Immediately: Verify this October 22, 2025 revision is the current active Humana Medicare Advantage policy for Firdapse in your billing system by visiting https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a426b6f. Update your prior authorization protocols to reflect: (1) All Firdapse requests require prior authorization confirmation of LEMS diagnosis by specialist (neurologist or equivalent); (2) Clinical evidence required: electromyography results OR VGCC auto-antibody documentation must accompany authorization requests; (3) Automatic denial trigger: Do NOT submit authorization requests for patients with documented seizure history—these are absolute contraindications per prescribing information. Billing team: Flag all Firdapse claims in your system requiring prior auth verification. Front desk: Ensure providers complete specialist verification and clinical test documentation before submitting pharmacy authorizations. Failure to obtain proper prior authorization will result in claim denials from Humana Medicare Advantage.