Medicare AdvantagePrior AuthMedium impact
Calcitonin gene-related peptide (CGRP) inhibitors (Revised)
Humana·Neurology, Pain Management, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage revised prior authorization requirements for CGRP inhibitors (Aimovig, Ajovy, Emgality) effective January 1, 2025. For migraine prevention, Aimovig and Ajovy now require prior trials of both Emgality AND Qulipta, while Emgality requires prior verapamil trial failure for episodic cluster headaches.
Action Required
By January 1, 2025: Update prior authorization protocols for CGRP inhibitors in Humana Medicare Advantage patients. For Aimovig and Ajovy migraine prevention requests, document prior trials of both Emgality AND Qulipta. For Emgality cluster headache requests, document verapamil trial failure and episodic cluster headache diagnosis criteria. Train staff on new step therapy requirements to avoid claim denials.