Medicare AdvantagePrior AuthMedium impact
Helicobacter Pylori Agents (Revised)
Humana·Gastroenterology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires step therapy for H. pylori treatment medications, mandating members try or prove inability to use Talicia before coverage of other H. pylori combination packs like Omeclamox-Pak, Voquezna Dual/Triple Pak, and Pylera. This adds a prior authorization requirement with specific criteria that must be met.
Action Required
By January 1, 2025: Billing team must update prior authorization workflows for H. pylori medications. Before prescribing Omeclamox-Pak, Voquezna Dual Pak, Voquezna Triple Pak, or Pylera for Humana Medicare Advantage patients, providers must document that patient has tried Talicia or cannot use Talicia. Update EMR templates to include this requirement and train staff on new step therapy criteria to avoid claim denials.