Medicare AdvantagePrior AuthMedium impact
Furoscix® (furosemide) (Revised)
Humana·Cardiology, Nephrology, Internal Medicine +2 more·Medicare Advantage
Effective date
Dec 28, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Furoscix (furosemide) subcutaneous injection prior authorization policy, effective December 28, 2022, with the most recent revision dated December 17, 2025. The policy requires prior authorization for Furoscix and mandates that patients meet three criteria: diagnosis of heart failure or chronic kidney disease (including nephrotic syndrome), documented edema, and previous treatment with oral loop diuretics. Billing teams must ensure all Furoscix claims include prior authorization and verify patients meet all eligibility criteria before processing.
Action Required
By December 17, 2025 (retroactively): Billing team must implement prior authorization requirement for all Furoscix (furosemide) subcutaneous wearable injector kit claims on Medicare Advantage plans. Before submitting any Furoscix claims: (1) Verify member meets ALL three criteria in the policy (heart failure OR CKD/nephrotic syndrome diagnosis + documented edema + prior oral loop diuretic use); (2) Obtain prior authorization through Humana's preauthorization system (reference www.humana.com/PAL for medical and procedural coding); (3) Document evidence of previous loop diuretic treatment (e.g., furosemide tablets) in the claim submission. Provider teams should verify patient eligibility and clinical criteria BEFORE administering Furoscix. Claims submitted without prior authorization or lacking documentation of required criteria will be denied.