Medicare AdvantagePrior AuthMedium impact
Opipza™ oral film (New)
Humana·Psychiatry, Pediatrics, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Opipza™ oral film (aripiprazole) effective January 1, 2026, for Medicare Advantage plans. Requires specific age criteria and trial of generic alternatives before approval for schizophrenia, major depressive disorder, and autism/Tourette's-related irritability.
Action Required
By January 1, 2026: Billing team must update prior authorization requirements for Opipza™ oral film prescriptions. Verify patients meet age criteria (13+ for schizophrenia, 18+ for MDD, 6+ for autism/Tourette's) and document trial/failure of required generic alternatives before submitting authorization requests. Claims without proper prior authorization will be denied.