Medicare AdvantagePrior AuthMedium impact
Aduhelm® (aducanumab-avwa) (Revised)
Humana·Neurology, Geriatrics, Internal Medicine +1 more·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Aduhelm (aducanumab-avwa) pharmacy coverage policy, effective November 26, 2025. The policy now requires that ALL Aduhelm requests—both initial and renewal—mandate enrollment in an FDA-approved randomized controlled trial or NIH-supported clinical trial as the sole approval criterion. This is a restrictive coverage policy that essentially limits Aduhelm access to trial participants only.
Action Required
By November 26, 2025: Billing and prior authorization teams must immediately update authorization workflows to require documentation of trial enrollment for ALL Aduhelm requests. (1) Update the prior authorization system to flag Aduhelm claims and require proof of FDA-approved RCT or NIH trial enrollment before approval. (2) Create or revise the PA request form template to specifically request trial name, trial ID, and enrollment verification documentation. (3) Communicate new requirements to all prescribing providers—Aduhelm will NOT be approved for any patient outside of an approved clinical trial, regardless of disease stage or clinical indication. (4) Train prior authorization staff that this policy supersedes any previous coverage criteria; the single approval criterion is trial enrollment only. (5) Implement denial templates for non-trial patients with specific language directing providers to CMS National Coverage Determination (NCD) 200.3 for alternative coverage pathways. Failure to enforce this criterion will result in inappropriate approvals and potential claim denials or recoupments from Humana.