Medicare AdvantagePrior AuthHigh impact
Spritam® (levetiracetam) (Revised)
Humana·Neurology, Pediatrics, Internal Medicine·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Spritam (levetiracetam) pharmacy coverage policy effective October 22, 2025, implementing a step therapy requirement. Members must have prior therapy with levetiracetam AND at least one alternative anticonvulsant (lamotrigine, carbamazepine, topiramate, divalproex, or phenytoin) before Spritam approval. This is a gatekeeping requirement that will affect prescription authorization workflows.
Action Required
By October 22, 2025: (1) Billing and prior authorization teams must update pharmacy authorization protocols to require step therapy documentation verification before processing Spritam requests. (2) Update preauthorization submission templates to capture evidence of prior levetiracetam therapy AND prior therapy with one of the five specified alternative anticonvulsants (lamotrigine, Subvenite, carbamazepine, topiramate, divalproex, or phenytoin). (3) Train pharmacy staff and medical reviewers on the dual-criteria approval requirements. (4) Configure pharmacy management system to flag Spritam requests for Medicare Advantage members and require step therapy documentation. (5) Notify providers prescribing to Humana Medicare Advantage patients that Spritam now requires prior authorization with step therapy criteria. Claims submitted without documented step therapy completion will be denied.