Medicare AdvantagePrior AuthLow impact
Voydeya™ (danicopan) tablet (Revised)
Humana·Hematology, Internal Medicine·Medicare Advantage
Effective date
Sep 25, 2024
We identified it
Jul 23, 2026
Summary
This is a new Medicare Advantage prior authorization policy for Voydeya (danicopan) tablet, effective September 25, 2024. The policy requires prior authorization for Voydeya as add-on therapy to eculizumab or ravulizumab in PNH patients with clinically significant extravascular hemolysis. Billing teams must implement prior authorization requirements and validate that all four clinical criteria are met before claims are processed.
Action Required
By September 25, 2024: Billing team must implement prior authorization requirement for Voydeya (danicopan) claims on Medicare Advantage plans. Before submitting claims, verify that: (1) member has PNH diagnosed by hematologist or PNH specialist, (2) member is currently on eculizumab or ravulizumab, (3) Voydeya is prescribed as add-on therapy (not monotherapy), and (4) member has clinically significant EVH with HgB ≤9.5 g/dL AND absolute reticulocyte count ≥120×10⁹/L. Deny claims if member uses Voydeya as monotherapy or with drugs other than eculizumab/ravulizumab. For renewal requests, confirm continued concomitant use of eculizumab or ravulizumab. Update billing software and prior authorization workflows to route all Voydeya requests to medical director review. Refer providers to www.humana.com/PAL for applicable preauthorization codes.