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Eltrombopag Olamine Products (Promacta® and generics) (New)
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 30, 2026
Summary
Humana Medicare Advantage has implemented a new prior authorization policy for Eltrombopag Olamine (Promacta and generics) effective January 1, 2027. The policy requires prior authorization for three indications: persistent/chronic immune thrombocytopenia (ITP), thrombocytopenia in hepatitis C patients, and aplastic anemia. Initial approvals are valid for 6 months, with renewals based on platelet count thresholds (<400 x10⁹/L) and indication-specific clinical criteria.
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What to do
by Dec 31, 2026 · 6 steps
01Billing and clinical teams must implement prior authorization workflows for all Promacta and eltrombopag olamine claims submitted to Humana Medicare Advantage.
02Update billing system to flag all Promacta/eltrombopag claims for prior auth review before submission.
03Establish clinical documentation requirements: Providers must document diagnosis (ITP, HCV-related thrombocytopenia, or aplastic anemia), current platelet count, prior therapy attempts (corticosteroids or IVIG for ITP; interferon status for HCV; immunosuppressive therapy status for aplastic anemia), and clinical justification.
04Create intake checklist for clinical staff to verify: platelet counts meet thresholds (ITP: <30 or 30-50 with bleeding; HCV: <75; Aplastic anemia: any with immunosuppressive combo), prior treatment requirements are documented, and patient meets indication-specific criteria.
05Establish renewal tracking system—claims require reauthorization at plan year intervals with current platelet count verification (must be <400 x10⁹/L).
06Brief providers on discontinuation rules: therapy must stop if platelet count exceeds 400 x10⁹/L after 2 weeks at lowest dose, or if insufficient response after 4 weeks at max dose (75 mg daily).
If missed: Failure to obtain prior authorization will result in claim denials from Humana Medicare Advantage.
Original notice
Eltrombopag Olamine Products (Promacta® and generics) (New)
mcp.humana.com · Always check the source before changing claims.