Medicare AdvantagePrior AuthMedium impact
Zonisade™ (zonisamide) (Revised)
Humana·Neurology, Pharmacy·Medicare Advantage
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Zonisade (zonisamide) oral suspension prior authorization policy effective June 24, 2026. The policy now requires prior authorization for this adjunctive seizure medication and mandates that members must have failed or be unable to use zonisamide capsules AND at least one other antiepileptic drug before approval. This is a revision to the original October 26, 2022 policy.
Action Required
By June 24, 2026: Billing and clinical teams must implement prior authorization requirements for Zonisade (zonisamide) oral suspension (100mg/5mL) for Medicare Advantage members. Update billing system to flag all Zonisade oral suspension claims for prior auth review. Ensure providers document: (1) diagnosis of partial-onset (focal) seizures, (2) concurrent use with at least one other antiepileptic drug, and (3) prior treatment failure or contraindication to zonisamide capsules AND at least one other antiepileptic drug (levetiracetam, lamotrigine, carbamazepine, divalproex, gabapentin, or topiramate). Submit prior auth requests to Humana through the PAL system at www.humana.com/PAL before dispensing. Claims submitted without prior authorization will be denied. Front desk and billing staff should verify member eligibility and prior auth status before appointment confirmation.