Medicare AdvantagePrior AuthMedium impact
Allergy Ophthalmics (New)
Humana·Ophthalmology, Optometry, Allergy & Immunology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a new step therapy policy for allergy eye drops (Bepreve, bepotastine, Zerviate) effective January 1, 2026. Prior authorization is now required and patients must have tried and failed or have contraindications to both azelastine and cromolyn eye drops before these medications will be covered.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for allergy ophthalmic medications (Bepreve, bepotastine, Zerviate) for Humana Medicare Advantage patients. Providers must document previous treatment failure, contraindication, or intolerance to both azelastine eye drops and cromolyn eye drops before prescribing covered medications. Update EMR templates to include required documentation. Visit www.humana.com/PAL for specific preauthorization requirements and medical coding information.