Medicare AdvantagePrior AuthMedium impact
Long Acting Muscarinic Antagonist / Long Acting Beta Agonist Combo Inhalers (Revised)
Humana·Pulmonology, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for LAMA/LABA combination inhalers (Duaklir Pressair, Anoro Ellipta, Bevespi Aerosphere, umeclidinium-vilanterol) effective January 1, 2025. Patients must have a COPD diagnosis and have failed or cannot tolerate Stiolto Respimat AND Spiriva before these medications will be approved.
Action Required
By January 1, 2025: Billing team must obtain prior authorization for all LAMA/LABA combination inhaler prescriptions (Duaklir Pressair, Anoro Ellipta, Bevespi Aerosphere, umeclidinium-vilanterol) for Medicare Advantage patients. Ensure documentation shows COPD diagnosis and previous treatment failure/contraindication/intolerance to both Stiolto Respimat AND Spiriva. Visit www.humana.com/PAL for specific authorization requirements. Claims without prior authorization will be denied.