Medicare AdvantagePrior AuthMedium impact
Vyalev® (foscarbidopa/foslevodopa) (Revised)
Humana·Neurology·Medicare Advantage
Effective date
Feb 26, 2025
We identified it
Jun 25, 2026
Summary
Humana has issued a revised Medicare Advantage prior authorization policy for Vyalev® (foscarbidopa/foslevodopa) effective February 26, 2025. The policy requires prior authorization for this continuous subcutaneous infusion therapy for advanced Parkinson's disease patients with motor fluctuations uncontrolled by optimized carbidopa/levodopa and who have tried or cannot use specific adjunctive anti-Parkinson agents (COMT inhibitors, MAO-B inhibitors, dopamine agonists, or amantadine). Claims submitted without meeting all four criteria will be denied.
Action Required
By February 26, 2025: Billing team must implement prior authorization requirements for all Vyalev (foscarbidopa/foslevodopa) infusion claims submitted to Humana Medicare Advantage plans. Update billing system to flag all Vyalev requests for mandatory prior auth review. Providers must document in claim submissions: (1) advanced Parkinson's disease diagnosis; (2) persistent motor fluctuations despite optimized carbidopa/levodopa therapy; (3) proof that patient has tried or cannot use at least one of the four specified anti-Parkinson agent classes (COMT inhibitor, MAO-B inhibitor, dopamine agonist, or amantadine); and (4) any Brand vs. Generic (BvsD) coverage determination if applicable. Route all Vyalev requests through Humana's PAL system (www.humana.com/PAL) for preauthorization submission. Coordinate with neurology and movement disorder providers to ensure they submit required prior auth documentation with each prescription. Claims submitted without prior authorization or incomplete documentation will be denied.