Medicare AdvantagePrior AuthMedium impact
Ophthalmic Cyclosporine (Cequa®, Restasis®, Restasis MultiDose®, Vevye®) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for all brand ophthalmic cyclosporine products (Cequa, Restasis, Restasis MultiDose, Vevye) for dry eye disease treatment. Members must first try generic cyclosporine eye drops and Eysuvis before brand products will be approved.
Action Required
By January 1, 2025: Billing team must obtain prior authorization for all Humana Medicare Advantage members prescribed brand cyclosporine eye drops (Cequa, Restasis, Restasis MultiDose, Vevye). Providers must document previous treatment with or contraindication to generic cyclosporine eye drops AND Eysuvis before requesting approval. Update encounter forms and EMR templates to capture required documentation. Claims will be denied without proper prior authorization.