Medicare AdvantagePrior AuthMedium impact
Duavee® (conjugated estrogens/bazedoxifene tablet) (Revised)
Humana·OB-GYN, Endocrinology, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Duavee (conjugated estrogens/bazedoxifene tablet) for menopause symptoms and osteoporosis prevention. Patients must have tried and failed specific first-line treatments (SSRIs/venlafaxine for menopause symptoms, alendronate/Evista for osteoporosis) before approval.
Action Required
Immediately: Billing team must update systems to flag Duavee prescriptions for Medicare Advantage patients as requiring prior authorization. Providers must document previous treatment failure, intolerance, or contraindication to required first-line therapies (SSRIs/venlafaxine for menopause, alendronate/Evista for osteoporosis). Update encounter forms and EMR templates to capture this documentation. Claims will be denied without proper prior authorization.