Medicare AdvantagePrior AuthMedium impact
Envarsus XR® (tacrolimus extended-release) (Revised)
Humana·Nephrology, Transplant Surgery, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2019
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Envarsus XR (tacrolimus extended-release) effective January 1, 2019, with the most recent revision dated February 25, 2026. The policy maintains existing coverage criteria requiring patients to have received a kidney transplant, be using the medication for organ rejection prophylaxis, and be on concurrent immunosuppressive therapy. No substantive changes to coverage criteria are indicated in this revision; however, the policy has been formally reviewed and reissued, so billing teams must verify this is the current version being used for all authorization requests.
Action Required
By March 15, 2026: Billing and prior authorization teams must verify that this revised policy (revision date 2/25/2026) is loaded in your Humana authorization system and replace any older versions. Update internal policy references and staff training materials to cite the 2/25/2026 revision date. Confirm that all Envarsus XR prior authorization requests for Medicare Advantage members include documentation of: (1) kidney transplant status, (2) use for organ rejection prophylaxis, and (3) concurrent use with other immunosuppressants. Per the policy's black box warning, educate patients/caregivers about the appearance of Envarsus XR tablets to prevent medication errors. Coordinate with nephrology/transplant departments to ensure providers understand the requirement for concurrent immunosuppressant therapy. Do not proceed with manual claim submission until prior authorization is obtained. Denials may result if authorization criteria are not met.