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 now requires prior authorization 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 MS medications before these non-preferred options will be covered.
Action Required
By January 1, 2026: Billing team must update prior authorization tracking system to flag prescriptions for Aubagio, Bafiertam, Gilenya, Mayzent, Ponvory, Tascenso ODT, Tecfidera, and Vumerity for Humana Medicare Advantage patients. Providers must document patient has tried at least two preferred MS medications (dimethyl fumarate, fingolimod, glatiramer products, Kesimpta, or teriflunomide) or cannot use them before prescribing non-preferred options. Claims will be denied without proper prior authorization.