Medicare AdvantagePrior AuthMedium impact
Dartisla ODT (glycopyrrolate) (Revised)
Humana·Gastroenterology, Internal Medicine, Family Medicine +2 more·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana has revised its Dartisla ODT (glycopyrrolate) coverage policy, effective October 22, 2025. This is a step therapy policy requiring members to have previous treatment or intolerance to glycopyrrolate tablet before Dartisla ODT (the orally disintegrating formulation) will be covered for adjunct peptic ulcer treatment. This is a pharmacy policy affecting prior authorization requirements for this specific medication.
Action Required
By October 22, 2025: Pharmacy and billing teams must implement step therapy requirements for Dartisla ODT (glycopyrrolate) in the prior authorization system. Update pharmacy software to require documentation of previous glycopyrrolate tablet treatment or documented intolerance before approving Dartisla ODT claims. Train pharmacy staff and billing team to verify member history of glycopyrrolate use during the authorization process. Any Dartisla ODT claim submitted without evidence of prior glycopyrrolate tablet treatment or intolerance will be denied. Notify prescribers of this step therapy requirement through your standard communication channels.