Medicare AdvantagePrior AuthLow impact
Epidiolex® (cannabidiol) (Revised)
Humana·Neurology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated their prior authorization policy for Epidiolex (cannabidiol) used to treat seizures associated with three rare epilepsy conditions. The policy requires specialist prescription and documentation of failed prior treatments for Dravet Syndrome and Lennox-Gastaut Syndrome, while Tuberous Sclerosis Complex only requires diagnosis documentation.
Action Required
Immediately: For patients prescribed Epidiolex, billing team must ensure prior authorization is obtained before dispensing. Verify specialist (neurologist/epileptologist) is prescribing and document failed previous treatments for Dravet and Lennox-Gastaut syndromes. Update pharmacy coverage verification procedures to check for these requirements. Claims will be denied without proper prior authorization.