Medicare AdvantagePrior AuthMedium impact
Risperidone Orally Disintegrating Tablets (Revised)
Humana·Psychiatry, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
This is a step therapy policy for risperidone orally disintegrating tablets (Risperdal M-Tab) under Medicare Advantage plans. Coverage requires members to have previous treatment or documented intolerance with generic risperidone tablets before the disintegrating formulation will be approved. The policy was revised on February 25, 2026 with an effective date of January 1, 2023.
Action Required
Immediately: Billing and prior authorization teams must implement step therapy screening for all risperidone orally disintegrating tablet (Risperdal M-Tab) requests on Medicare Advantage plans. Before submitting authorization requests, verify in patient records that the member has documented prior treatment with or documented intolerance to generic risperidone tablets (standard tablet formulations). Update prior authorization workflow to require this documentation as a prerequisite—do not submit requests without evidence of the step therapy requirement being met. Flag non-compliant requests for provider follow-up. Failure to enforce this step therapy requirement may result in claim denials. Communicate this requirement to all prescribers submitting risperidone disintegrating tablet prescriptions.