Medicare AdvantagePrior AuthMedium impact
Ferriprox® (deferiprone) (Revised)
Humana·Hematology, Pharmacy, Pediatrics +1 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jul 1, 2026
Summary
Humana Medicare Advantage updated its Ferriprox (deferiprone) prior authorization policy effective January 1, 2024 (revised June 24, 2026). Coverage requires diagnosis of transfusional iron overload secondary to thalassemia syndromes with documented failure, contraindication, or intolerance to deferasirox, plus serum ferritin >2,500 mcg/L. Patients must demonstrate ≥20% decline in serum ferritin after therapy initiation or coverage may be denied. Billing teams must implement prior authorization requirements before dispensing either tablet or oral solution formulations.
Action Required
By January 1, 2024: Billing and pharmacy teams must implement prior authorization requirements for all Ferriprox (deferiprone) tablets and Ferriprox oral solution claims submitted to Humana Medicare Advantage. Establish PA workflow requiring: (1) documentation of thalassemia syndrome diagnosis with transfusion dependence, (2) serum ferritin level >2,500 mcg/L, (3) documented prior therapy failure, contraindication, or intolerance to deferasirox tablets. For renewal claims, require evidence of ≥20% serum ferritin decline since therapy initiation or claim will be denied. Update pharmacy system to flag all deferiprone prescriptions for mandatory PA submission to Humana before dispensing. Notify prescribers to include required clinical documentation with PA requests. Failure to obtain prior authorization will result in claim denials and patient out-of-pocket costs.