Medicare AdvantagePrior AuthMedium impact
Lumryz (sodium oxybate) (Revised)
Humana·Neurology, Sleep Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Lumryz (sodium oxybate) effective January 1, 2025, for Medicare Advantage plans. The policy requires prior authorization for this narcolepsy medication with specific clinical criteria including diagnosis confirmation and restrictions on concurrent use of similar medications.
Action Required
Immediately: Billing team must update prior authorization workflows to require pre-approval for all Lumryz (sodium oxybate) prescriptions for Medicare Advantage patients. Providers must document narcolepsy diagnosis (with or without cataplexy), confirm no concurrent use of similar medications (Xyrem, Xywav, Wakix, Sunosi), and for excessive daytime sleepiness cases, document sleep testing results and previous treatment failures with CNS stimulants and modafinil. Update EMR templates to include these documentation requirements.