Medicare AdvantagePrior AuthMedium impact
Zavzpret™ (zavegepant) (Revised)
Humana·Neurology, Pain Management, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has implemented a prior authorization requirement for Zavzpret (zavegepant) nasal spray for acute migraine treatment. Coverage requires documented failure, intolerance, or contraindication to both sumatriptan nasal spray AND Ubrelvy before approval. This is a CGRP receptor antagonist with a maximum 24-hour dose of 10 mg and safety data only supporting treatment of up to 8 migraines per 30-day period.
Action Required
By January 1, 2024 (retroactive effective date): Billing team must implement prior authorization process for all Zavzpret claims submitted to Humana Medicare Advantage plans. Before submitting claims, verify member has documented history of previous treatment failure, intolerance, or contraindication to BOTH sumatriptan nasal spray AND Ubrelvy. Create internal checklist to confirm both criteria are met before PA submission. Contact Humana PAL portal (www.humana.com/PAL) for specific medical and procedural coding requirements. Update claim submission protocols to flag Zavzpret prescriptions for prior auth verification. Failure to obtain required prior authorization will result in claim denials.