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, and Zerviate) effective January 1, 2026. Patients must first try and fail both azelastine eye drops and cromolyn eye drops before these medications will be covered.
Action Required
Before January 1, 2026: Billing team must verify step therapy requirements are met for Bepreve, bepotastine, and Zerviate prescriptions. Providers must document previous treatment, contraindication, or intolerance with both azelastine eye drops and cromolyn eye drops before prescribing covered medications. Update prior authorization workflows to include step therapy verification. Claims may be denied without proper documentation of step therapy compliance.