Medicare AdvantagePrior AuthMedium impact
Sirturo® (bedaquiline) (Revised)
Humana·Infectious Disease, Pulmonology, Internal Medicine·Medicare Advantage
Effective date
Sep 24, 2025
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Sirturo® (bedaquiline) for multidrug-resistant tuberculosis (MDR-TB), updated September 24, 2025. The policy requires prior authorization and maintains a 24-week approval duration for initial and renewal requests. The policy emphasizes bedaquiline's black box warnings for increased mortality and QT prolongation, requiring specific baseline and ongoing clinical monitoring before and during treatment.
Action Required
By September 24, 2025: Billing and clinical teams must implement prior authorization requirements for all Sirturo (bedaquiline) claims. Specifically: (1) Update billing system to flag all bedaquiline prescriptions as requiring prior auth before claim submission; (2) Ensure providers document pulmonary MDR-TB diagnosis with drug susceptibility testing (DST) confirmation on all prior auth requests; (3) Confirm bedaquiline is prescribed as part of a multidrug regimen (not monotherapy); (4) Set approval duration tracking in system for 24-week initial and renewal periods; (5) Add checklist to provider forms requiring documentation of baseline ECG, electrolyte levels (potassium, calcium, magnesium), and liver function tests (ALT, AST, alkaline phosphatase, bilirubin) before treatment initiation; (6) Flag all claims for ongoing monitoring compliance at weeks 2, 12, and 24 post-initiation. Without prior authorization, Humana Medicare Advantage claims will be denied. Contact Humana PAL (Preauthorization and Notification List) at www.humana.com/PAL for claim coding specifics.