Medicare AdvantageCoverageMedium impact
Compounded Medications (Revised)
Humana·Pharmacy, Pain Management, Neurology +3 more·Medicare Advantage
Effective date
Jul 23, 2025
We identified it
Jul 17, 2026
Summary
Humana revised its compounded medication coverage policy for Medicare Advantage plans, effective July 23, 2025. Compounded medications are now covered only if they meet Part D drug definitions with compendia support, reject with specific error codes (307 or 524), and contain no experimental/investigational ingredients. Billing teams must implement claims review procedures to ensure compounded medications comply with compendia-supported indications and dosage forms before submission.
Action Required
By August 23, 2025: Billing team must implement claims screening protocol for all compounded medication submissions to Humana Medicare Advantage plans. (1) Before submitting claims, verify that compounded medications contain only Part D drug components with compendia support for the prescribed indication and dosage form. (2) Confirm that prescriptions do NOT contain any of the specifically excluded ingredients (amantadine hcl, baclofen, budesonide ER, clompiramine hcl, cyclobenzaprine hcl, diclofenac ER, duloxetine hcl, gabapentin, hydrocortisone butyrate 0.1% solution, ibuprofen, ketoprofen, ketoprofen ER, lamotrigine, meloxicam, orphenadrine ER, piroxicam, tizanidine hcl, topiramate, tramadol hcl) in topical dosage forms. (3) Update billing system documentation templates to require providers to document compendia support (reference source from Lexicomp, Clinical Pharmacology, or Micromedex) at time of prescription entry. (4) Establish process to flag and hold claims that reject with error code 307 or 524 for manual clinical pharmacy review before resubmission. (5) Train billing staff to recognize when compounds lack Part D definition status and communicate denial reasons to providers. Failure to implement verification will result in repeated claim denials and delays in patient access to medications.