All Insurance Policy Changes (Page 175)

Continuing from page 174. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Vigabatrin products (Revised)
Humana·Effective Jan 1, 2024
Humana Medicare Advantage has revised its prior authorization policy for vigabatrin products (Vigadrone, Vigpoder, generic vigabatrin, Vigafyde) effective January 1, 2024, with updates as of June 24, 2026. The policy requires prior authorization for two indications: (1) Refractory Complex Partial Seizures—requiring documented failure of at least two other anticonvulsants plus concurrent use with another seizure medication, and (2) Infantile Spasms—requiring only documented diagnosis. All prescriptions must comply with the Vigabatrin REMS Program due to black box warnings regarding permanent vision loss.
High impact
Verzenio (abemaciclib) (Revised)
Humana·Effective Jan 1, 2024
Humana Medicare Advantage has revised its Verzenio (abemaciclib) prior authorization policy effective January 1, 2024, with the most recent revision dated January 28, 2026. The policy outlines four approved indications for this CDK 4/6 inhibitor in HR-positive, HER2-negative breast cancer with specific prior authorization requirements, approval durations of 6 months for both initial and renewal periods, and exclusions including prior CDK 4/6 inhibitor progression and a 2-year treatment limit for early breast cancer cases.
Medium impact
Vectibix (panitumumab) (Revised)
Humana·Effective Jan 1, 2024
Humana revised its Vectibix (panitumumab) prior authorization policy effective January 1, 2024, with updates as of December 17, 2025. The policy covers panitumumab for metastatic colorectal cancer in two distinct scenarios: (1) wild-type RAS patients as monotherapy or in combination with specific chemotherapy regimens, and (2) KRAS G12C-mutated patients in combination with sotorasib. All uses require prior authorization and RAS mutation status documentation; claims for unknown RAS status or after prior progression on panitumumab/cetuximab will be denied.
High impact
Varubi (rolapitant) (Revised)
Humana·Effective Jan 1, 2024
Humana updated its Varubi (rolapitant) prior authorization policy effective January 1, 2024, with a revision date of June 25, 2025. The policy requires prior authorization for Varubi tablet (90mg) when used for chemotherapy-induced nausea and vomiting prevention. Key requirements include: (1) documented failure or contraindication with aprepitant, (2) concurrent use with corticosteroid and 5-HT3 antagonist, and (3) use with highly or moderately emetogenic chemotherapy. The policy explicitly excludes concurrent use with IV Emend, oral Emend 150mg, Akynzeo, or Cinvanti.
Medium impact
Varizig (varicella zoster immune globulin) (Revised)
Humana·Effective Jan 1, 2024
Humana Medicare Advantage has revised its Varizig (varicella zoster immune globulin) pharmacy coverage policy, effective January 1, 2024 with updates as of February 25, 2026. This is a prior authorization policy requiring verification that patients meet specific high-risk criteria before Varizig is covered for post-exposure varicella zoster prophylaxis. Billing teams must ensure all Varizig claims include prior authorization documentation confirming the patient's high-risk status.
Medium impact
Ubrelvy™ (ubrogepant) (Revised)
Humana·Effective Jan 1, 2024
Humana has revised its Medicare Advantage prior authorization policy for Ubrelvy (ubrogepant) effective January 1, 2024, with the most recent revision dated January 28, 2026. The policy requires prior authorization for acute migraine treatment and mandates that members have documented previous treatment failure, intolerance, or contraindication to at least one triptan (naratriptan, rizatriptan, or sumatriptan) before Ubrelvy can be approved. Billing teams must ensure claims include evidence of failed triptan therapy to avoid denial.
Medium impact
iDose® TR (travoprost) intracameral implant (Revised)
Humana·Effective Jun 1, 2026
Humana has revised its prior authorization policy for iDose® TR (travoprost) intracameral implant for Medicaid members in Kentucky, South Carolina, and Virginia, effective June 1, 2026. The policy requires prior authorization for this glaucoma/ocular hypertension treatment and establishes specific approval criteria, exclusions (corneal endothelial cell dystrophy and prior corneal transplantation), and contraindications that billing teams must verify before claim submission.
High impact
Wegovy (semaglutide) (Revised)
Humana·Effective Jan 28, 2026
Humana Medicare Advantage has updated its Wegovy (semaglutide) prior authorization policy, effective January 28, 2026, to include two distinct coverage pathways: (1) cardiovascular risk reduction in overweight/obese patients with established CVD (non-diabetic), and (2) treatment of metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis (F2-F3). The policy requires prior authorization for both indications with specific clinical criteria and documentation requirements.
Medium impact
Wainua™ (eplontersen) (Revised)
Humana·Effective Mar 25, 2026
Humana has revised its Wainua (eplontersen) pharmacy coverage policy effective March 25, 2026, for treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis. This is a prior authorization policy affecting Medicare and Medicaid members in Kentucky, South Carolina, and Virginia. Coverage requires documentation of TTR gene mutation, active polyneuropathy with ruled-out alternative causes, polyneuropathy disability score of IIIb or lower, and no prior liver transplant history.
Medium impact
Zolgensma® (onasemnogene abeparvovec-xioi) (Revised)
Humana·Effective Jul 1, 2024
Humana updated its Zolgensma (onasemnogene abeparvovec-xioi) prior authorization policy for Medicaid in South Carolina, effective July 1, 2024, with revision date January 28, 2026. The policy establishes strict eligibility criteria for this gene therapy treatment of spinal muscular atrophy in infants under 2 years of age, including genetic confirmation, anti-AAV9 antibody testing, corticosteroid tolerance, and specialist oversight. Prior authorization is required before any claim submission, with approval limited to a single lifetime dose.
Medium impact
Zilretta® (triamcinolone acetonide extended-release injectable suspension) (Revised)
Humana·Effective Jan 28, 2026
Humana Indiana Medicaid has revised its Zilretta (triamcinolone acetonide extended-release) prior authorization policy effective January 28, 2026. The policy requires prior authorization for intra-articular knee injections and maintains strict criteria: documented symptomatic knee osteoarthritis, no prior Zilretta use in the same knee, and failure of two different short-acting intra-articular steroids. Initial and renewal approvals are limited to 6 months each.
Medium impact
Yescarta™ (axicabtagene ciloleucel) (Revised)
Humana·Effective Jul 1, 2024
Humana Medicaid (South Carolina) updated its Yescarta (axicabtagene ciloleucel) prior authorization policy effective July 1, 2024, with a revision date of May 1, 2026. The policy covers three indications for this CAR-T cell therapy: Large B-cell lymphoma (3L+), Large B-cell lymphoma (2L with specific refractoriness criteria), and Follicular lymphoma (2L+). All approvals are limited to a maximum of one dose per lifetime with 60-day authorization duration. Billing teams must implement prior authorization requirements and verify member eligibility against specific clinical criteria and five exclusion categories before claim submission.
Medium impact
Xeomin® (incobotulinumtoxinA) (Revised)
Humana·Effective Jul 1, 2024
Humana updated its Xeomin (incobotulinumtoxinA) prior authorization policy for South Carolina Medicaid, effective July 1, 2024, with a revision date of June 24, 2026. The policy clarifies four covered indications (blepharospasm, cervical dystonia, chronic sialorrhea, and upper limb spasticity in adults and select pediatric patients) and maintains an extensive exclusion list prohibiting coverage for non-covered indications including migraine, back pain, cosmetic uses, and pediatric cerebral palsy spasticity. Prior authorization remains required for all Xeomin claims under this plan.
Medium impact
Vyvgart (efgartigimod alfa-fcab) & Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) (Revised)
Humana·Effective Jul 1, 2024
Humana Medicaid in South Carolina has revised its prior authorization policy for Vyvgart (efgartigimod alfa-fcab) and Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc), effective July 1, 2024, with most recent updates August 27, 2025. The policy covers two indications: generalized myasthenia gravis (gMG) for both formulations and chronic inflammatory demyelinating polyneuropathy (CIDP) for Vyvgart Hytrulo only. Prior authorization is required for all uses, with specific clinical criteria including confirmed diagnosis, specialist supervision (neurologist), and documented prior treatment/contraindications to first-line therapies.
High impact
Viscosupplements (Revised)
Humana·Effective Jul 1, 2024
This revised Humana Medicaid-Indiana viscosupplement policy (effective July 1, 2024, revised March 1, 2026) establishes prior authorization requirements for 18 hyaluronic acid injection products used to treat knee osteoarthritis. The policy requires documented symptomatic knee OA, previous treatment/contraindication/intolerance with two specific products (Durolane, Euflexxa, Gelsyn-3, or Supartz FX) for certain alternatives, and a 6-month interval between treatment cycles for re-treatment requests.
Medium impact
Xolremdi (mavorixafor) (Revised)
Humana·Effective Sep 25, 2024
Humana Medicare Advantage has issued a new prior authorization policy for Xolremdi (mavorixafor), a rare disease treatment for WHIM syndrome. All requests require prior authorization with three strict approval criteria: confirmed WHIM diagnosis via CXCR4 genotype, baseline ANC ≤400 cells/μL, and prescription by a specialist (immunologist, hematologist, geneticist, infectious disease, or dermatologist). Initial approvals are for 6 months; renewals require documented increase in ANC or decreased infection frequency.
Medium impact
Voydeya™ (danicopan) tablet (Revised)
Humana·Effective Sep 25, 2024
Humana Medicare Advantage has issued a revised prior authorization policy for Voydeya (danicopan) tablet, effective immediately (revised July 23, 2025). This is a pharmacy coverage policy requiring prior auth for danicopan use as add-on therapy to eculizumab or ravulizumab in PNH patients with clinically significant extravascular hemolysis. Billing teams must ensure all Voydeya claims include documentation of PNH diagnosis, concurrent C5 inhibitor use, and specific hemoglobin/reticulocyte count criteria before submission.
Medium impact
Voranigo (vorasidenib) (Revised)
Humana·Effective Sep 25, 2024
Humana Medicare Advantage has revised its prior authorization policy for Voranigo (vorasidenib), a targeted therapy for grade 2 gliomas with IDH1/IDH2 mutations. The policy requires prior authorization for this specialty oncology medication when used as single-agent adjuvant therapy post-surgery in patients 12 years and older. Billing teams must implement prior authorization workflows and ensure claims meet three specific clinical criteria or will be denied.
Medium impact
Vyloy (zolbetuximab-clzb) (Revised)
Humana·Effective Nov 27, 2024
Humana has updated its prior authorization policy for Vyloy (zolbetuximab-clzb), a newly approved cancer immunotherapy for HER2-negative gastric and gastroesophageal junction adenocarcinoma. The policy applies to Medicare, Kentucky Medicaid, and South Carolina Medicaid and requires prior authorization before dispensing. Key approval criteria include CLDN18.2-positive disease confirmation via FDA-approved test and use as first-line combination chemotherapy. The policy was revised on August 27, 2025 with a review date of August 20, 2025.
Medium impact
Yorvipath® (palopegteriparatide) (Revised)
Humana·Effective Dec 18, 2024
Humana Medicare Advantage has issued a new prior authorization policy for Yorvipath (palopegteriparatide) effective December 18, 2024, for treating chronic hypoparathyroidism in adults. Prior authorization is now required, and coverage is limited to patients meeting specific clinical criteria including failed conventional therapy, normal vitamin D levels, adequate serum calcium, and endocrinologist prescription. Acute post-surgical hypoparathyroidism is excluded from coverage.
Medium impact
Zymfentra (infliximab-dyyb) (Revised)
Humana·Effective Jan 1, 2025
Humana Medicare Advantage has issued a revised prior authorization policy for Zymfentra (infliximab-dyyb) effective January 1, 2025. The policy requires prior authorization for both ulcerative colitis and Crohn's disease indications, with approval contingent on patients having either failed/been intolerant to TWO specific biologic therapies (adalimumab products, ustekinumab products, Skyrizi, Rinvoq, or Tremfya) OR completed induction with IV infliximab. Billing teams must verify prior authorization status before claims submission to avoid denials.
High impact
Zilbrysq (zilucoplan) (Revised)
Humana·Effective Jan 1, 2025
Humana has revised its prior authorization policy for Zilbrysq (zilucoplan) for Medicare Advantage members with generalized myasthenia gravis (gMG). The policy requires prior authorization and establishes four mandatory approval criteria: confirmed gMG diagnosis, anti-AChR antibody presence, specialist supervision (neurologist), and prior trial or contraindication of Vyvgart products. Critical alert: The drug carries a BLACK BOX WARNING requiring meningococcal vaccination at least 2 weeks before first dose and enrollment in the ZILBRYSQ REMS program.
Medium impact
Zavesca® (miglustat) (Revised)
Humana·Effective Jan 1, 2025
Humana Medicare Advantage has updated its Zavesca (miglustat) prior authorization policy effective January 1, 2025, with a revision dated January 28, 2026. The policy requires prior authorization for miglustat use in Medicare Advantage members with type 1 Gaucher disease who have failed or are intolerant to Elelyso (taliglucerase) therapy. Coverage is approved in plan year durations for both initial and renewal requests.
High impact
Yervoy (ipilimumab) (Revised)
Humana·Effective Jan 1, 2025
Humana revised its Yervoy (ipilimumab) prior authorization policy effective January 1, 2025, with updates finalized June 25, 2025. The policy applies to Medicare and Medicaid (Florida, Kentucky, South Carolina) and establishes prior authorization requirements across seven cancer indications, including melanoma, renal cell carcinoma, colorectal cancer, hepatocellular carcinoma, NSCLC, mesothelioma, and esophageal cancer. Key requirements include ECOG performance status 0-2, Yervoy naïveté for initial approvals, and combination therapy mandates for most non-melanoma indications.
Medium impact
Xywav® (calcium, magnesium, potassium, and sodium oxybates) (Revised)
Humana·Effective Jan 1, 2025
Humana Medicare Advantage has updated its prior authorization policy for Xywav® (calcium, magnesium, potassium, and sodium oxybates), effective January 1, 2025. The policy covers three indications: narcolepsy with cataplexy, narcolepsy with excessive daytime sleepiness, and idiopathic hypersomnia. All three indications now require prior authorization with specific clinical criteria, including prior sodium oxybate treatment and documentation of diagnostic testing. Claims must also demonstrate the member is using only one competing product at a time.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Vigabatrin products (Revised)

Verzenio (abemaciclib) (Revised)

Vectibix (panitumumab) (Revised)

Varubi (rolapitant) (Revised)

Varizig (varicella zoster immune globulin) (Revised)

Ubrelvy™ (ubrogepant) (Revised)

iDose® TR (travoprost) intracameral implant (Revised)

Wegovy (semaglutide) (Revised)

Wainua™ (eplontersen) (Revised)

Zolgensma® (onasemnogene abeparvovec-xioi) (Revised)

Zilretta® (triamcinolone acetonide extended-release injectable suspension) (Revised)

Yescarta™ (axicabtagene ciloleucel) (Revised)

Xeomin® (incobotulinumtoxinA) (Revised)

Vyvgart (efgartigimod alfa-fcab) & Vyvgart® Hytrulo (efgartigimod alfa and hyaluronidase-qvfc) (Revised)

Viscosupplements (Revised)

Xolremdi (mavorixafor) (Revised)

Voydeya™ (danicopan) tablet (Revised)

Voranigo (vorasidenib) (Revised)

Vyloy (zolbetuximab-clzb) (Revised)

Yorvipath® (palopegteriparatide) (Revised)

Zymfentra (infliximab-dyyb) (Revised)

Zilbrysq (zilucoplan) (Revised)

Zavesca® (miglustat) (Revised)

Yervoy (ipilimumab) (Revised)

Xywav® (calcium, magnesium, potassium, and sodium oxybates) (Revised)