Medicare AdvantagePrior AuthMedium impact
GnRH Receptor Antagonists (Myfembree®, Oriahnn®) (New)
Humana·OB-GYN, Endocrinology, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for GnRH receptor antagonists (Myfembree and Oriahnn) used to treat heavy menstrual bleeding from uterine fibroids and endometriosis pain. Approval requires specific diagnosis criteria, previous treatment failures, and excludes patients with osteoporosis.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflow for Myfembree and Oriahnn prescriptions for Medicare Advantage patients. Providers must document diagnosis of uterine fibroids or endometriosis, confirm premenopausal status, document previous treatment failures with tranexamic acid (fibroids) or hormonal contraceptives/NSAIDs (endometriosis), and verify no history of osteoporosis. Initial approvals are for 6 months with 6-month renewals, maximum 24 months total. Claims without prior authorization will be denied.