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HumanaMedicaid · Prior Auth · Medicaid · LA · Psychiatry, Geriatrics, Family Medicine +1 moreMedium impact

Antipsychotic Utilization Program (New)

Effective date
Oct 1, 2025
Identified
Jun 24, 2026

Summary

Humana Louisiana Medicaid has implemented a new antipsychotic utilization program requiring prior authorization for antipsychotic medications prescribed to patients with documented dementia diagnoses. The program includes strict age-based criteria and specific compendia-supported indications for approval.

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What to do

Action · 5 steps
01Before October 1, 2025: Billing team must update prior authorization requirements for all antipsychotic medications (both typical and atypical) when prescribed to patients 65+ with dementia diagnoses.
02Verify patient age and diagnosis codes before prescribing.
03Obtain prior auth unless patient has documented schizophrenia, bipolar disorder, Huntington's disease, or Tourette's syndrome.
04Update billing system to flag dementia-related ICD-10 codes.
05Claims without proper prior authorization will be denied.

Codes mentioned

A81.00A81.01A81.09F01.50F01.51F02.80F02.81F03.90F03.91F05F10.27F10.96F10.97F13.27F13.97F18.97F19.17F19.27F19.97G30.0G30.1G30.8G30.9G31.01G31.83

Original notice

Antipsychotic Utilization Program (New)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Antipsychotic Utilization Program (Revised)MediumEffective Jan 1, 2019 · MedicaidAntipsychotic Utilization Program (Revised)MediumEffective Jun 10, 2026 · MedicaidBrowse every Humana change in the policy list

Related policy hubs

Humana policiesLA policy changesPsychiatryGeriatricsFamily MedicineInternal MedicineCode A81.00Code A81.01Code A81.09Code F01.50Code F01.51Code F02.80Code F02.81Code F03.90Code F03.91Code F05Code F10.27Code F10.96Code F10.97Code F13.27Code F13.97Code F18.97Code F19.17Code F19.27Code F19.97Code G30.0Code G30.1Code G30.8Code G30.9Code G31.01Code G31.83

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