Medicare AdvantagePrior AuthMedium impact
Eohilia™ (budesonide oral suspension) (New)
Humana·Gastroenterology, Allergy & Immunology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Eohilia (budesonide oral suspension) for eosinophilic esophagitis treatment. The drug requires meeting 5 specific criteria including diagnosis confirmation, dysphagia episodes, duration limits, and failure of other treatments including Dupixent.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for Eohilia (budesonide oral suspension) prescriptions. Providers must document all 5 criteria: EoE diagnosis with ≥15 eosinophils per HPF, ≥4 dysphagia episodes in 2 weeks, treatment duration ≤12 weeks, failure of PPI or topical corticosteroid, and failure of Dupixent. Update EMR templates to include these documentation requirements. Claims will be denied without proper prior authorization.