MedicaidPrior AuthMedium impact
Antipsychotic Utilization Program (New)
Humana·LA · Psychiatry, Geriatrics, Family Medicine +1 more·Medicaid
Effective date
Oct 1, 2025
We identified it
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.
Action Required
Before 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. Verify patient age and diagnosis codes before prescribing. Obtain prior auth unless patient has documented schizophrenia, bipolar disorder, Huntington's disease, or Tourette's syndrome. Update billing system to flag dementia-related ICD-10 codes. Claims without proper prior authorization will be denied.