Medicare AdvantagePrior AuthMedium impact
Qulipta (atogepant) (Revised)
Humana·Neurology, Family Medicine, Internal Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jul 23, 2026
Summary
Humana Medicare Advantage has established a prior authorization requirement for Qulipta (atogepant), a CGRP receptor antagonist used for migraine prevention in adults. The policy requires prior auth approval for initial and renewal periods, with specific dosage adjustments for patients with severe renal impairment or ESRD. This is a new pharmacy coverage policy effective January 1, 2025.
Action Required
By January 1, 2025: Billing and pharmacy teams must implement prior authorization workflow for Qulipta (atogepant) prescriptions for all Medicare Advantage members. Update pharmacy system and billing software to require prior auth submission before claim processing. Providers prescribing Qulipta must submit PA requests through Humana's system (reference www.humana.com/PAL for coding requirements). Train front desk, clinical, and billing staff on the PA requirement. Ensure approval is obtained for both initial prescriptions and annual renewals. Failure to obtain prior authorization will result in claim denials and potential member out-of-pocket costs.