Medicare AdvantagePrior AuthMedium impact
Viibryd® (vilazodone) (Revised)
Humana·Psychiatry, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its prior authorization policy for Viibryd® (vilazodone) effective January 1, 2024, with a revision date of April 22, 2026. The policy requires prior authorization for vilazodone treatment of major depressive disorder, with mandatory documentation of prior therapy or documented intolerance/contraindication to SSRIs AND either generic bupropion or mirtazapine before approval. This is a revised policy (not new), indicating coverage criteria have been clarified or modified from a prior version.
Action Required
Before January 1, 2024 (retroactively, as this is now in effect): Billing and clinical teams must implement prior authorization requirements for all Viibryd® (vilazodone) claims for Medicare Advantage members. Specifically: (1) Require providers to document DSM-5 diagnosis of major depressive disorder AND use of a validated depression rating scale (PHQ-9, CUDOS, QIDS-SR16, MADRS, or HAM-D) on all Viibryd® requests; (2) Require evidence of prior therapy failure, intolerance, or contraindication to BOTH an SSRI (fluoxetine, citalopram, sertraline, or equivalent) AND either generic bupropion (specified dosages: 75mg/100mg IR, 100mg/150mg/200mg SR, or 150mg/300mg XL) OR mirtazapine before Viibryd® will be approved; (3) Update billing system and prior authorization workflows to enforce these criteria; (4) Alert providers through update notices that claims lacking this documentation will be denied; (5) Train front-desk and prior authorization staff on the two-medication failure requirement. Review the full policy at www.humana.com/PAL for complete preauthorization requirements.