Medicare AdvantagePrior AuthMedium impact
Seroquel XR® (quetiapine fumarate) extended release tablets (Revised)
Humana·Psychiatry, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage plans now require prior authorization for Seroquel XR (quetiapine fumarate) extended release tablets for all covered indications including schizophrenia, bipolar disorder, and major depressive disorder. The policy includes specific criteria that must be met for approval, including documentation of prior therapy failures with other medications.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Seroquel XR prescriptions for Humana Medicare Advantage patients before dispensing. Providers must document diagnosis (schizophrenia, bipolar disorder, or major depressive disorder) and prior therapy failures as specified in the policy criteria. Update pharmacy systems to flag Seroquel XR for prior auth requirements. Claims will be denied without proper prior authorization.