Medicare AdvantagePrior AuthMedium impact
Rexulti® (brexpiprazole) (Revised)
Humana·Psychiatry, Neurology, Geriatrics +2 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Rexulti (brexpiprazole) effective January 1, 2025, adding agitation associated with dementia due to Alzheimer's disease as a covered indication alongside existing major depressive disorder and schizophrenia coverage. The policy now includes specific criteria that members must meet for each indication and prohibits 'as needed' use for dementia-related agitation.
Action Required
By January 1, 2025: Billing team must ensure prior authorization is obtained for all Rexulti (brexpiprazole) prescriptions for Humana Medicare Advantage members. Providers must document specific clinical criteria including diagnosis confirmation, prior therapy attempts or contraindications, and for major depressive disorder cases, ensure adjunctive use with antidepressant therapy. Update prior authorization request forms to include required clinical documentation for the three covered indications.