Medicare AdvantagePrior AuthMedium impact
Kapspargo™ Sprinkle (metoprolol succinate) (Revised)
Humana·Cardiology, Internal Medicine, Geriatrics·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Kapspargo™ Sprinkle (metoprolol succinate) pharmacy coverage policy effective November 26, 2025. This is a step therapy policy requiring members to have prior treatment with at least two generic beta blockers (carvedilol, atenolol, or metoprolol tartrate/succinate) before Kapspargo coverage is approved. The policy applies to Medicare Advantage plans and includes contraindications for severe bradycardia, heart block, sick sinus syndrome without pacemaker, cardiogenic shock, or decompensated heart failure.
Action Required
By November 26, 2025: Pharmacy and billing teams must implement step therapy requirements for Kapspargo™ Sprinkle (metoprolol succinate) in the prior authorization system for all Medicare Advantage claims. Update pharmacy management software to flag any Kapspargo requests and require documentation of prior treatment with at least two of the following: carvedilol tablet, atenolol tablet, or metoprolol (tartrate or succinate). Communicate with prescribing providers that prior authorization will be denied if this step therapy criterion is not met. Verify member charts document prior beta blocker therapy before processing approvals. Claims submitted without documented prior step therapy will be denied. Ensure pharmacy staff are trained on the contraindicated conditions (severe bradycardia, heart block >1st degree, sick sinus syndrome without pacemaker, cardiogenic shock, decompensated heart failure) and flag these for denial.