Medicare AdvantagePrior AuthMedium impact
Gimoti (metoclopramide) (Revised)
Humana·Gastroenterology, Endocrinology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana Medicare Advantage revised its Gimoti (metoclopramide nasal spray) pharmacy coverage policy effective July 22, 2026. The policy requires prior authorization for Gimoti in Medicare Advantage members with diabetic gastroparesis who have failed or are intolerant to generic metoclopramide. Key exclusion: members with a history of tardive dyskinesia or dystonic reaction to metoclopramide are not eligible. The policy emphasizes the black box warning regarding tardive dyskinesia risk and limits treatment duration to 12 weeks unless longer-term use is unavoidable with monitoring.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirement for all Gimoti (metoclopramide nasal spray) claims submitted for Medicare Advantage members. Specifically: (1) Update prior authorization system to require PA submission for Gimoti nasal spray prescriptions; (2) Ensure PA requests include verification that member has diagnosed diabetic gastroparesis AND prior treatment failure or documented intolerance to generic metoclopramide (tablet or solution); (3) Flag and deny any requests from members with documented history of tardive dyskinesia or dystonic reaction to metoclopramide; (4) Educate providers that PA approval covers the plan year duration initially, with renewal available for subsequent plan years; (5) Communicate to providers and pharmacy staff that treatment should not exceed 12 weeks without documented medical necessity and ongoing monitoring for tardive dyskinesia; (6) Update billing software system edits to block claims lacking required prior authorization documentation. Failure to implement PA requirements will result in claim denials.