Medicare AdvantagePrior AuthMedium impact
Veozah® (fezolinetant) (Revised)
Humana·OB-GYN, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Veozah® (fezolinetant) effective April 22, 2026. The policy requires prior authorization for this neurokinin 3 receptor antagonist used to treat moderate to severe vasomotor symptoms in menopausal patients. Coverage requires documented diagnosis of moderate to severe vasomotor symptoms AND prior treatment failure, contraindication, or intolerance to hormone therapy or SSRI/SNRI medications. Billing teams must implement prior authorization requirements and educate providers on the two mandatory approval criteria.
Action Required
By April 22, 2026: Billing team must implement prior authorization requirement in billing system for Veozah® (fezolinetant) 45mg tablets under Humana Medicare Advantage plans. Update authorizations workflow to require documentation of: (1) moderate to severe vasomotor symptoms diagnosis, AND (2) previous treatment/contraindication/intolerance to menopausal hormone therapy (estradiol, estradiol-norethindrone acetate) or SSRI/SNRI (citalopram, fluoxetine, paroxetine, venlafaxine, desvenlafaxine). Notify providers to include prior medication trial documentation with prior authorization requests. Configure system to approve claims for initial plan year duration and renewal plan year duration. Claims submitted without prior authorization will be denied. Flag all Veozah prescriptions for prior auth review before claim submission.