Medicare AdvantageAdministrativeMedium impact
Early Refill Edits on Topical Ophthalmic Products
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Mar 13, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented new early refill edits and maximum dispensing limits for topical eye drops and ophthalmic products. The policy establishes standardized calculations for medication quantity limits based on 20 drops per mL and assumes bilateral eye use, allowing refills at 70% of predicted usage duration.
Action Required
Immediately: Billing and pharmacy teams must understand that Humana Medicare Advantage members using topical eye drops will face new quantity limits and early refill restrictions. When members report issues obtaining refills before 70% of expected usage time, assist with prior authorization requests through Humana's Clinical Pharmacy Review process for quantities exceeding maximum dispensing limits. Update staff training on these restrictions for ophthalmology patients.