Medicare AdvantagePrior AuthMedium impact
Osphena® (ospemifene) (New)
Humana·OB-GYN, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a new prior authorization policy for Osphena (ospemifene) tablets effective January 1, 2026. The medication requires prior auth for post-menopausal women with vulvar/vaginal atrophy experiencing moderate to severe dyspareunia or vaginal dryness, with documentation of previous treatment failure or contraindication to estradiol or Premarin vaginal cream.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for Osphena (ospemifene) prescriptions for Humana Medicare Advantage patients. Providers must document post-menopausal status, moderate to severe dyspareunia or vaginal dryness, vulvar/vaginal atrophy, and previous treatment failure or contraindication to estradiol or Premarin vaginal cream. Update EMR templates to include required clinical criteria. Failure to obtain prior authorization will result in claim denials.