Medicare AdvantagePrior AuthMedium impact
Intranasal Rhinitis Agents (Revised)
Humana·Allergy & Immunology, Family Medicine, Internal Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a step therapy policy for intranasal rhinitis agents (nasal sprays for allergies) effective January 1, 2026. Members must try TWO generic first-line treatments (fluticasone, azelastine, flunisolide, or mometasone nasal sprays) before coverage will be approved for brand-name or specialty nasal rhinitis medications.
Action Required
Before January 1, 2026: Providers treating allergic rhinitis must document that patients have tried at least TWO of the following first-line nasal sprays before prescribing brand-name alternatives: fluticasone, azelastine, flunisolide, or mometasone nasal spray. Update EMR templates to include step therapy documentation for intranasal rhinitis agents. Claims for Patanase, Dymista, Omnaris, Beconase AQ, Zetonna, QNASL, and Ryaltris will be denied without proof of prior trials.