Medicare AdvantagePrior AuthMedium impact
Ubrelvy™ (ubrogepant) (Revised)
Humana·Neurology, Pain Management, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana has revised its Medicare Advantage prior authorization policy for Ubrelvy (ubrogepant) effective January 1, 2024, with the most recent revision dated January 28, 2026. The policy requires prior authorization for acute migraine treatment and mandates that members have documented previous treatment failure, intolerance, or contraindication to at least one triptan (naratriptan, rizatriptan, or sumatriptan) before Ubrelvy can be approved. Billing teams must ensure claims include evidence of failed triptan therapy to avoid denial.
Action Required
Before submitting Ubrelvy claims to Humana Medicare Advantage: (1) Billing team must verify in the member's chart that ONE of the following criteria is documented: previous treatment with naratriptan, rizatriptan, or sumatriptan; documented intolerance to one of these triptans; or documented contraindication to one of these triptans. (2) Obtain prior authorization before dispensing—do not process claims without PA approval. (3) Include documentation of triptan failure/intolerance/contraindication with the PA request to prevent denial. (4) Front desk/intake staff should flag Ubrelvy requests during verification and route to clinical staff for PA submission. (5) Update pharmacy billing system to flag Ubrelvy as a PA-required medication for Humana MA members. Failure to obtain prior authorization or provide triptan history documentation will result in claim denials.