Medicare AdvantagePrior AuthHigh impact
Dupixent® (dupilumab) injection (Revised)
Humana·Allergy & Immunology, Dermatology, Pulmonology +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Dupixent (dupilumab) injection, expanding coverage criteria to include nine conditions with specific age, diagnostic, and treatment failure requirements. This policy revision affects both syringe and pen injector formulations with detailed approval criteria for each indication.
Action Required
By January 1, 2026: Update prior authorization workflows for Dupixent (dupilumab) injections for Humana Medicare Advantage patients. Billing team must ensure providers document specific criteria for each of the nine covered conditions including age requirements, diagnostic confirmation, previous treatment failures, and lab values where specified (e.g., eosinophil counts). Create checklist templates for each indication to ensure all criteria are met before submitting prior authorization requests. Claims will be denied without proper prior authorization approval.