Medicare AdvantagePrior AuthMedium impact
Uptravi® (selexipag) (Revised)
Humana·Pulmonology, Cardiology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 28, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Uptravi® (selexipag) effective January 1, 2026, with updates as of May 27, 2026. The policy requires prior authorization for all Uptravi formulations (tablets and IV solution) for pulmonary arterial hypertension treatment, with mandatory criteria including confirmed PAH diagnosis via right heart catheterization and prior therapy/intolerance to at least one endothelin receptor antagonist.
Action Required
By January 1, 2026: Billing and prior authorization teams must implement prior authorization requirements for all Uptravi (selexipag) claims submitted to Humana Medicare Advantage plans. Update billing system to flag prescriptions for: Uptravi tablets (all doses: 100-1600 mcg), Uptravi dose packs, and Uptravi IV solution (1800 mcg). Before submitting claims, verify member meets BOTH criteria: (1) documented PAH diagnosis confirmed by right heart catheterization, and (2) prior therapy/intolerance/contraindication to at least one endothelin receptor antagonist (ambrisentan, bosentan, or macitentan). Train prior auth staff to review documentation for these requirements. Instruct providers to include right heart catheterization confirmation and endothelin receptor antagonist history in prior auth requests. Failure to obtain prior authorization will result in claim denials for Medicare Advantage members.