Medicare AdvantagePrior AuthMedium impact
Fetzima® (levomilnacipran) (Revised)
Humana·Psychiatry, Internal Medicine, Family Medicine·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Fetzima® (levomilnacipran) effective July 22, 2026. The policy requires prior authorization for all Fetzima use in Medicare Advantage members and mandates documentation of prior therapy, intolerance, or contraindication to SNRIs (duloxetine, venlafaxine, desvenlafaxine ER) AND either generic bupropion or mirtazapine before approval for major depressive disorder treatment.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for all Fetzima® prescriptions submitted under Humana Medicare Advantage plans. Update billing software to flag Fetzima claims and route to prior auth department. Providers must submit documentation with prior auth requests showing: (1) patient has major depressive disorder diagnosis, (2) documented trial, intolerance, or contraindication to at least one SNRI (duloxetine, venlafaxine, or desvenlafaxine ER), AND (3) documented trial, intolerance, or contraindication to generic bupropion (75mg/100mg IR, 100mg/150mg/200mg SR, or 150mg/300mg XL) OR mirtazapine. Billing team should update claim submission templates and provider communication materials to reflect new prior auth requirement. Note: Policy applies to Fetzima capsule extended-release 24-hour formulations only. Claims submitted without prior authorization or incomplete documentation will be denied.