Medicare AdvantagePrior AuthLow impact
Ravicti® (glycerol phenylbutyrate) (Revised)
Humana·Genetics, Pediatrics, Internal Medicine·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Ravicti® (glycerol phenylbutyrate) prior authorization policy on November 26, 2025. The policy maintains existing coverage criteria requiring diagnosis of urea cycle disorders, concurrent use with low-protein diet, and prior trial/contraindication of sodium phenylbutyrate products. A critical exclusion remains: Ravicti is not covered for N-acetylglutamate synthetase (NAGS) deficiency treatment. No changes to approval duration or billing codes were made in this revision.
Action Required
By December 10, 2025: Verify that your billing system reflects the current Ravicti prior authorization requirements for Medicare Advantage members. Ensure that all authorization requests include documentation of: (1) confirmed UCD diagnosis, (2) concurrent low-protein diet implementation, and (3) evidence of prior sodium phenylbutyrate trial or contraindication. Billing staff should confirm the NAGS deficiency exclusion is documented in your prior auth checklist to prevent claim denials. No workflow changes are required unless your current procedures do not already enforce these criteria. Contact Humana PAL (www.humana.com/PAL) for claim code information if needed.