Medicare AdvantagePrior AuthMedium impact
Oxtellar XR® (oxcarbazepine extended release) (Revised)
Humana·Neurology, Pediatrics, General Practice·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its pharmacy coverage policy for Oxtellar XR (oxcarbazepine extended release) effective October 22, 2025. This is a step therapy policy requiring members to have prior therapy with or intolerance to immediate-release oxcarbazepine (generic Trileptal) before Oxtellar XR will be covered. The policy applies to Medicare Advantage members with seizure disorders and specifies important clinical considerations including monitoring for hyponatremia, serious dermatological reactions, and suicidal ideation.
Action Required
By October 22, 2025: Billing team must update prior authorization workflows to enforce step therapy requirements for Oxtellar XR claims. When processing Oxtellar XR prescriptions for Humana Medicare Advantage members, verify that member documentation shows prior therapy with or documented intolerance to immediate-release oxcarbazepine (generic Trileptal) before submitting for authorization. Update claim submission procedures and staff training to identify Oxtellar XR claims requiring step therapy documentation. Claims submitted without evidence of prior IR oxcarbazepine therapy or intolerance will be denied. Notify providers serving Medicare Advantage members that prior auth requests for Oxtellar XR must include documentation of previous immediate-release oxcarbazepine use or intolerance.