Medicare AdvantagePrior AuthMedium impact
Clozapine orally disintegrating tablet and Versacloz® (clozapine oral solution)
Humana·Psychiatry·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for clozapine orally disintegrating tablets and Versacloz oral solution, effective January 1, 2026. Members must have treatment-resistant schizophrenia and have tried or been intolerant to generic clozapine tablets first.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for clozapine ODT and Versacloz prescriptions for Humana Medicare Advantage members. Providers must document treatment-resistant schizophrenia diagnosis and prior therapy/intolerance to generic clozapine tablets. Update pharmacy billing system to flag these medications for prior auth. Claims will be denied without proper authorization.