Medicare AdvantagePrior AuthMedium impact
Fanapt® (iloperidone) (Revised)
Humana·Psychiatry·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Fanapt (iloperidone), requiring documentation of failure, intolerance, or contraindication to at least 2 specific alternative antipsychotics before approval. This affects prescribing for schizophrenia and bipolar I disorder treatments.
Action Required
Immediately: Providers prescribing Fanapt (iloperidone) for Humana Medicare Advantage patients must document prior therapy, intolerance, or contraindication to at least 2 of the following medications: risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, or lurasidone (for schizophrenia) before submitting prior authorization requests. Update EMR templates to include this documentation requirement. Claims without proper documentation will be denied.