Medicare AdvantagePrior AuthMedium impact
Sublingual Allergen Extract (Revised)
Humana·Allergy & Immunology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for three sublingual allergen extract tablets (Ragwitek, Grastek, Odactra) effective January 1, 2026. Members must meet three criteria including failed conventional treatments before approval.
Action Required
Before January 1, 2026: Billing team must implement prior authorization requirements for Ragwitek, Grastek, and Odactra sublingual tablets for Humana Medicare Advantage members. Update billing system to flag these medications. Providers must document: 1) allergic rhinitis diagnosis, 2) positive skin test or IgE antibody testing, 3) failed treatment with nasal corticosteroid AND nasal antihistamine. Claims will be denied without proper prior authorization.