Medicare AdvantagePrior AuthMedium impact
Duopa® (carbidopa and levodopa) (Revised)
Humana·Neurology·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Duopa (carbidopa/levodopa) enteral suspension for Medicare Advantage members with advanced Parkinson's disease. The policy requires members to meet 5 specific criteria including having a PEG-J tube and CADD pump system, with approval duration of one plan year for both initial and renewal requests.
Action Required
Immediately: Review current Duopa (carbidopa/levodopa) enteral suspension patients to ensure all 5 prior authorization criteria are documented including advanced Parkinson's diagnosis, persistent motor fluctuations despite optimized therapy, trial of anti-Parkinson agents, presence of PEG-J tube with CADD Legacy 1400 pump, and BvsD coverage determination if required. Update prior authorization request processes to include all required criteria documentation. Reauthorize annually for existing patients.