Medicare AdvantagePrior AuthHigh impact
Anticholinergic Polypharmacy Agents (Revised)
Humana·FL, SC, IN, OK, VA · Pharmacy, Geriatrics, Psychiatry +4 more·Medicaid
Effective date
May 13, 2026
We identified it
Jun 25, 2026
Summary
Humana has updated its Anticholinergic Polypharmacy guidance (revised May 13, 2026) to implement a safety edit that restricts concurrent use of multiple anticholinergic medications for members aged 65+, unless the provider attests that benefits outweigh risks per American Geriatrics Society Beers Criteria and provides patient education. Members in hospice are exempt from this restriction. This affects pharmacy claims across Medicare and multiple state Medicaid programs.
Action Required
By May 13, 2026: Billing and pharmacy teams must implement the following changes: (1) Update pharmacy billing system to flag and apply safety edits for concurrent anticholinergic medications (antihistamines, antiparkinsons, skeletal muscle relaxants, TCAs, paroxetine, antipsychotics, antimuscarinics, antispasmodics, antiemetics) for all members aged 65+ across affected plans; (2) Establish prior authorization workflow requiring provider attestation that medical benefits outweigh risks per AGS Beers Criteria and documentation of patient education before approving concurrent anticholinergic polypharmacy; (3) Exempt hospice members from the safety edit—ensure system flags reflect hospice status; (4) Train providers on attestation requirements and documentation standards; (5) Update claim adjudication rules to deny concurrent anticholinergic claims lacking proper provider attestation and patient education documentation. Failure to implement will result in inappropriate claim denials and potential quality measure penalties under the Pharmacy Quality Alliance Polypharmacy measure.