Medicare AdvantagePrior AuthMedium impact
Dihydroergotamine Products (Revised)
Humana·Neurology, Pain Management, Emergency Medicine·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jul 22, 2026
Summary
Humana revised its Dihydroergotamine Products prior authorization policy (effective January 1, 2022, revised July 22, 2026). The policy requires prior authorization for dihydroergotamine injection and nasal spray when used for acute migraine treatment. Patients must meet two criteria: use for moderate to severe migraine headaches and documented previous treatment, intolerance, or contraindication to at least TWO of the following agents (naproxen, naratriptan, rizatriptan, or sumatriptan). Approval is granted for the plan year duration with annual renewal.
Action Required
By August 22, 2026 (implementation of recent revision): Billing and prior authorization teams must ensure the system enforces the two-agent prior trial requirement before approving dihydroergotamine injection or nasal spray claims. Update authorization request forms to require documentation of patient failure, intolerance, or contraindication to TWO of the following: naproxen tablet, naratriptan tablet, rizatriptan tablet, or sumatriptan tablet. Train billing staff and providers that dihydroergotamine products require prior authorization for Medicare Advantage members. Set approval duration to plan year with annual renewal cycles. Verify member meets both clinical criteria (acute moderate-to-severe migraine use) and medication trial history before submitting claims. Lack of proper prior authorization will result in claim denials. Reference www.humana.com/PAL for applicable medical and procedural coding information for medically billed requests.