Medicare AdvantagePrior AuthMedium impact
Fast Facts Newsletter - February (Special Edition) 2025
HealthPartners·MN · Pulmonology, Endocrinology, Rheumatology +3 more·Pharmacy
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
HealthPartners is implementing multiple pharmacy formulary changes including removing Promacta from commercial formulary (Alvaiz preferred), adding prior authorization requirements for 12 Medicare medications, and updating weight loss surgery coverage criteria effective April 1, 2025.
Action Required
By April 1, 2025: Update prior authorization workflows for Medicare patients receiving Cinqair, Vyepti, Fasenra, Leqvio, Nucala, Orencia, Pasireotide, Simponi Aria, Tezspire, Entyvio IV, Xolair, and Zinplava. For commercial patients, switch new Promacta prescriptions to Alvaiz. Update weight loss surgery authorization criteria to exclude adjustable gastric banding and include mental health evaluation requirements within 12 months. Claims will be denied without proper prior authorization.