Medicare AdvantagePrior AuthMedium impact
Brekiya® (dihydroergotamine mesylate) (Revised)
Humana·Neurology, Pain Management, Emergency Medicine·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jul 21, 2026
Summary
Humana Medicare Advantage has implemented a revised prior authorization policy for Brekiya (dihydroergotamine mesylate) subcutaneous auto-injector, effective December 17, 2025, with a revision date of July 22, 2026. Coverage now requires prior authorization for acute migraine treatment (requires failure/intolerance of Ubrelvy AND one triptan/NSAID) and cluster headache treatment (requires failure/intolerance of at least two triptans). Billing teams must implement prior authorization screening before claims submission to prevent denials.
Action Required
Before December 17, 2025: Billing and clinical teams must implement prior authorization workflow for all Brekiya prescriptions for Medicare Advantage members. Specifically: (1) Update billing system/EMR to flag Brekiya claims as requiring prior authorization; (2) Create or update prior auth request templates requiring documentation of previous treatment/intolerance to Ubrelvy plus one triptan or NSAID (for migraine) or two triptans (for cluster headache); (3) Brief providers and clinical staff on the two separate authorization pathways (migraine vs. cluster headache); (4) Do not submit claims without prior authorization approval, as they will be denied. Route all requests through Humana's Prior Authorization and Notification List at www.humana.com/PAL. Failure to obtain prior authorization will result in claim denials.