Medicare AdvantagePrior AuthLow impact
Dichlorphenamide Products (Revised)
Humana·Neurology, Internal Medicine, Genetics·Medicare Advantage
Effective date
Sep 24, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Dichlorphenamide Products (Keveyis, Ormalvi, generic dichlorphenamide) prior authorization policy effective September 24, 2025. The policy requires prior authorization for these carbonic anhydrase inhibitor medications used to treat rare periodic paralysis disorders. Coverage requires documentation of primary hyperkalemic or hypokalemic periodic paralysis diagnosis AND prior treatment failure, contraindication, or intolerance with acetazolamide.
Action Required
By September 24, 2025: Billing and clinical teams must implement prior authorization requirements for all dichlorphenamide product claims (Keveyis, Ormalvi, generic dichlorphenamide tablets) for Medicare Advantage members. Update billing system to flag these medications for mandatory PA submission. Ensure providers document: (1) confirmed diagnosis of primary hyperkalemic or hypokalemic periodic paralysis or related variants (Paramyotonia Congenita, Andersen-Tawil Syndrome), and (2) prior acetazolamide treatment with documented failure, contraindication, or intolerance. Route PA requests through www.humana.com/PAL using appropriate medical/procedural codes. Claims submitted without prior authorization will be denied. Train front desk and billing staff to verify prior authorization status before claim submission. This is a rare disease indication affecting approximately 5,000 U.S. patients, so minimal claim volume is expected.