Medicare AdvantagePrior AuthLow impact
Hetlioz® and Hetlioz LQ™ (tasimelteon) (Revised)
Humana·Sleep Medicine, Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Hetlioz and Hetlioz LQ (tasimelteon) effective January 1, 2025. The policy requires documented diagnosis and specific criteria for Non-24-Hour Sleep-Wake Disorder and Smith-Magenis Syndrome, with brand products requiring previous trial or intolerance to generic tasimelteon.
Action Required
Immediately: Billing and authorization staff must obtain prior authorization for all Hetlioz and Hetlioz LQ prescriptions for Humana Medicare Advantage patients. Ensure providers document diagnosis of Non-24-Hour Sleep-Wake Disorder or Smith-Magenis Syndrome with nighttime sleep disturbances. For brand requests, document previous trial or intolerance to generic tasimelteon. Claims without prior authorization will be denied.