Medicare AdvantagePrior AuthMedium impact
Dexilant® (dexlansoprazole) (Revised)
Humana·Gastroenterology, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Feb 28, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Dexilant (dexlansoprazole) pharmacy coverage policy, effective February 28, 2024. This is a step therapy policy requiring members to have previous treatment with or intolerance to at least two specific proton pump inhibitors (omeprazole, pantoprazole, or esomeprazole) before Dexilant coverage is approved. Billing teams must verify step therapy requirements are met before submitting claims to avoid denials.
Action Required
By February 28, 2024: Billing team and providers must implement step therapy verification for all Dexilant (dexlansoprazole) requests for Humana Medicare Advantage members. Before submitting claims or dispensing Dexilant, verify that the member has documented evidence of previous treatment with or intolerance to at least two of the following: omeprazole delayed-release capsules, pantoprazole delayed-release tablets, or esomeprazole magnesium delayed-release capsules. Update pharmacy claims submission processes and prior authorization workflows to enforce this requirement. Communicate with prescribing providers that Dexilant requests will require this prior step therapy documentation. Claims submitted without evidence of step therapy completion will be denied. Ensure EMR/pharmacy system flags this requirement for Medicare Advantage members only.