Medicare AdvantagePrior AuthMedium impact
Clemastine fumarate syrup (Revised)
Humana·Allergy & Immunology, Family Medicine, General Practice +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for clemastine fumarate syrup (oral antihistamine) effective January 1, 2026. Patients must have failed or cannot tolerate two other antihistamines for allergic rhinitis, or one second-generation antihistamine for urticaria before approval.
Action Required
Immediately: Billing team must verify prior authorization is obtained before prescribing clemastine fumarate syrup for Medicare Advantage patients. Providers must document patient has failed or cannot tolerate required alternative medications (cetirizine, fluticasone nasal spray, or levocetirizine for allergic rhinitis; second-generation antihistamines for urticaria). Claims without prior auth will be denied.