CommercialPrior AuthMedium impact
Calcitonin gene-related peptide (CGRP) inhibitors (Revised)
Humana·Neurology, Pain Management, Internal Medicine +1 more·Commercial
Effective date
Mar 27, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its CGRP inhibitor prior authorization policy effective March 27, 2024. For migraine prevention with Ajovy and Emgality (120 mg/mL), the policy now requires prior treatment failure with Aimovig OR Nurtec ODT OR Qulipta (with a Medicaid-South Carolina exception). This expands the previous step-therapy requirements and clarifies which agents satisfy initial treatment failure criteria before approving second-line CGRP inhibitors.
Action Required
By April 15, 2024: Billing and prior authorization staff must update internal clinical guidelines and PA submission templates to reflect the revised step-therapy hierarchy for CGRP inhibitors. When processing Ajovy or Emgality requests for migraine prevention, verify that the member has documented treatment failure (less than 50% reduction in migraine days) with at least one of: Aimovig, Nurtec ODT, or Qulipta. For Medicaid-South Carolina members, do not require prior Nurtec or Qulipta treatment—Aimovig failure alone satisfies criteria. Update provider-facing materials and EMR templates to reflect these changes. Flag all pending PA requests submitted under the old criteria for review and resubmission if necessary. Claims submitted without documentation of appropriate step-therapy will be denied.