Medicare AdvantagePrior AuthMedium impact
Igalmi™ (dexmedetomidine) (Revised)
Humana·Psychiatry, Emergency Medicine·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has updated its prior authorization policy for Igalmi™ (dexmedetomidine) sublingual film, effective January 28, 2026. This is a pharmacy coverage policy requiring prior authorization for acute treatment of agitation associated with schizophrenia or bipolar I or II disorder in Medicare Advantage members. The policy mandates approval based on two criteria: confirmed diagnosis of schizophrenia or bipolar I/II disorder AND current agitation associated with these conditions.
Action Required
By January 28, 2026: Billing and pharmacy teams must implement prior authorization requirements for Igalmi™ (dexmedetomidine) sublingual film (120 mcg and 180 mcg) in the billing system for all Humana Medicare Advantage members. Update clinical decision support and pharmacy verification workflows to require documentation of: (1) confirmed diagnosis of schizophrenia or bipolar I or II disorder, and (2) evidence of current agitation. Train prescribers and front-desk staff that claims for Igalmi will be denied without prior authorization approval. Coordinate with Humana PAL (Preauthorization and Notification List) at www.humana.com/PAL for specific medical billing code submissions. Note: This medication has a 24-hour limitation of use from first dose per FDA labeling.