Medicare AdvantagePrior AuthHigh impact
Non-Preferred Multiple Sclerosis Injectable Products (New)
Humana·Neurology·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for multiple sclerosis injectable medications (Avonex, Rebif, Plegridy, Extavia, Betaseron, Copaxone) starting January 1, 2026. Patients must have relapsing MS or clinically isolated syndrome and must have tried at least two preferred oral medications first.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for MS injectable medications (Avonex, Rebif, Plegridy, Extavia, Betaseron, Copaxone) for Medicare Advantage patients. Providers must document relapsing MS diagnosis and trial/failure of at least two preferred medications (dimethyl fumarate, fingolimod, glatiramer products, Kesimpta, or teriflunomide). Update encounter forms and EMR templates to capture required documentation. Claims will be denied without proper prior authorization.