Medicare AdvantagePrior AuthMedium impact
GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)
Humana·OB-GYN, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a new prior authorization requirement effective January 1, 2026 for GnRH receptor antagonists Myfembree and Oriahnn. These medications treat heavy menstrual bleeding from uterine fibroids and endometriosis pain, requiring specific diagnostic criteria, previous treatment failures, and excluding patients with osteoporosis.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Myfembree and Oriahnn prescriptions for Humana Medicare Advantage patients. Providers must document diagnosis of uterine fibroids or endometriosis, confirm premenopausal status, verify previous treatment failures with tranexamic acid (fibroids) or hormonal contraceptives/NSAIDs (endometriosis), and exclude osteoporosis. Update EMR templates to include required criteria documentation. Claims will be denied without proper prior authorization.