Medicare AdvantagePrior AuthMedium 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 is implementing new prior authorization requirements for non-preferred MS injectable products (Avonex, Rebif, Plegridy, Extavia, Betaseron, and Copaxone). Patients must have tried or cannot use at least two preferred oral/injectable MS therapies before these products will be approved.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows for MS injectable medications (Avonex, Rebif, Plegridy, Extavia, Betaseron, Copaxone) for Humana Medicare patients. Providers must document diagnosis of relapsing MS or CIS and document trial/failure of at least two preferred therapies (dimethyl fumarate, fingolimod, glatiramer products, Kesimpta, or teriflunomide) before prescribing. Update EMR templates to capture required documentation. Claims will be denied without proper prior authorization.