Medicare AdvantagePrior AuthMedium impact
Ohtuvayre ™(ensifentrine) (Revised)
Humana·SC, VA · Pulmonology, Internal Medicine, Family Medicine +1 more·Medicaid
Effective date
Oct 23, 2024
We identified it
Jun 24, 2026
Summary
Humana has established a new prior authorization policy for Ohtuvayre (ensifentrine), a nebulized COPD medication, effective October 23, 2024. Patients must have tried or have contraindications to LABA/LAMA therapy before approval, and the medication requires prior authorization for Medicare and Medicaid coverage in South Carolina and Virginia.
Action Required
Immediately: Billing and clinical teams must implement prior authorization requirements for Ohtuvayre (ensifentrine) prescriptions for Humana Medicare and Medicaid patients in South Carolina and Virginia. Verify patients have COPD diagnosis and document previous treatment with or contraindications to LABA/LAMA medications before submitting prior auth requests. Claims will be denied without proper authorization.