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 is implementing a new prior authorization policy for Osphena (ospemifene) tablets effective January 1, 2026. The medication requires prior approval for postmenopausal women with moderate to severe dyspareunia or vaginal dryness who have tried or cannot tolerate estradiol or Premarin vaginal cream.
Action Required
By January 1, 2026: Clinical staff must obtain prior authorization for all Osphena (ospemifene) prescriptions for Medicare Advantage patients. Verify patient meets all three criteria: 1) postmenopausal status, 2) moderate to severe dyspareunia OR vaginal dryness with vulvar/vaginal atrophy, and 3) previous trial, intolerance, or contraindication to estradiol or Premarin vaginal cream. Update EMR templates to document these requirements. Claims will be denied without proper prior authorization.