Medicare AdvantagePrior AuthMedium impact
Non-Preferred Oral Multiple Sclerosis Products (New)
Humana·Neurology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing new prior authorization requirements for non-preferred oral multiple sclerosis medications including Aubagio, Bafiertam, Gilenya, Mayzent, Ponvory, Tascenso ODT, Tecfidera, and Vumerity. Patients must have tried at least two preferred alternatives before these medications will be approved.
Action Required
By January 1, 2026: Update prior authorization workflows for non-preferred oral MS medications (Aubagio, Bafiertam, Gilenya, Mayzent, Ponvory, Tascenso ODT, Tecfidera, Vumerity). Ensure documentation shows patient has tried at least two preferred alternatives: dimethyl fumarate, fingolimod, glatiramer products, Kesimpta, or teriflunomide. Alert providers that prescriptions will require prior auth and may be denied without proper documentation of failed trials.