Medicare AdvantagePrior AuthMedium impact
FILSPARI® (sparsentan) (Revised)
Humana·Nephrology, Internal Medicine·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana has revised its FILSPARI (sparsentan) prior authorization policy for Medicare Advantage members, effective July 22, 2026. The policy covers two indications: primary IgAN (requiring biopsy confirmation, ACEi/ARB trial/failure or contraindication, and eGFR ≥30) and FSGS without nephrotic syndrome (age 8+, requiring ACEi/ARB trial/failure or contraindication, and eGFR ≥30). Key update: pregnancy testing requirement was removed from the REMS program in August 2025, though pregnancy must still be excluded before initiation. Prior authorization is required for all FILSPARI prescriptions.
Action Required
By July 22, 2026: Update billing system and prior authorization processes to reflect revised FILSPARI criteria. Billing team must ensure: (1) Prior authorization is submitted for all FILSPARI requests with diagnosis confirmation (IgAN biopsy-confirmed or FSGS without nephrotic syndrome); (2) Verification that member has failed or has contraindication to ACEi/ARB; (3) Confirmation of baseline eGFR ≥30 mL/min/1.73m² prior to approval; (4) For FSGS cases, verification that member is age 8 or older; (5) Documentation that FILSPARI REMS program enrollment requirements are met at dispensing pharmacy. Remove obsolete pregnancy testing documentation requirements (eliminated August 2025) from authorization checklists. Update prior auth templates to reference the July 22, 2026 revision date. Failure to follow updated criteria will result in claim denials. Coordinate with providers to ensure accurate diagnosis coding (IgAN vs FSGS designation) on authorization requests.