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Anticholinergic Polypharmacy Agents (Revised)
Act
by May 13, 2026
Effective date
May 13, 2026
Identified
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.
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What to do
by May 13, 2026 · 6 steps
01Billing and pharmacy teams must implement the following changes.
02Update 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.
03Establish 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.
04Exempt hospice members from the safety edit—ensure system flags reflect hospice status.
05Train providers on attestation requirements and documentation standards.
06Update claim adjudication rules to deny concurrent anticholinergic claims lacking proper provider attestation and patient education documentation.
If missed: Failure to implement will result in inappropriate claim denials and potential quality measure penalties under the Pharmacy Quality Alliance Polypharmacy measure.
Original notice
Anticholinergic Polypharmacy Agents (Revised)
mcp.humana.com · Always check the source before changing claims.