Medicare AdvantagePrior AuthMedium impact
Uloric® (febuxostat) (Revised)
Humana·Rheumatology, Internal Medicine, Pharmacy·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Uloric (febuxostat) step therapy policy effective January 28, 2026. The policy reinforces that febuxostat requires prior step therapy—patients must have documented previous treatment failure, intolerance, or contraindication to allopurinol before approval. The policy emphasizes the 2019 FDA black box warning regarding cardiovascular death risk in gout patients with established cardiac disease, requiring careful risk-benefit assessment by providers.
Action Required
By January 28, 2026: Billing team must ensure prior authorization system flags all Uloric (febuxostat) claims as requiring step therapy verification. Providers must document one of the following in claims: (1) patient's previous allopurinol treatment with inadequate response at maximally titrated dose, (2) documented allopurinol intolerance, or (3) contraindication to allopurinol. Front desk staff should update patient intake forms to capture allopurinol trial history before prescriptions are written. During authorization review, medical team must verify allopurinol step therapy requirement is met before approval. Flag any cardiovascular disease history in patient records—if present, ensure providers document risk-benefit analysis in medical record. Claims without documented step therapy failure or contraindication will be denied.