Medicare AdvantagePrior AuthMedium impact
Preferred Multiple Sclerosis Products (Revised)
Humana·Neurology, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their prior authorization policy for preferred Multiple Sclerosis products, now requiring authorization for generic versions of dimethyl fumarate, fingolimod, glatiramer acetate, Glatopa, Kesimpta, and teriflunomide. Members must have a diagnosis of relapsing MS or clinically isolated syndrome to qualify for coverage.
Action Required
By January 1, 2026: Billing team must update prior authorization protocols for Multiple Sclerosis medications including generic dimethyl fumarate, fingolimod, glatiramer acetate, Glatopa, Kesimpta, and teriflunomide for Humana Medicare Advantage members. Providers must document diagnosis of relapsing MS or clinically isolated syndrome before prescribing. Update EMR templates to include required diagnostic criteria.