Medicare AdvantagePrior AuthMedium impact
Austedo® & Austedo® XR (deutetrabenazine) (Revised)
Humana·Neurology, Psychiatry, Pharmacy·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana updated its Medicare Advantage prior authorization policy for Austedo® & Austedo® XR (deutetrabenazine) on June 25, 2025. The policy maintains prior authorization requirements for tardive dyskinesia and chorea associated with Huntington's disease, with approval duration for both initial and renewal covering the plan year. Key clinical criteria remain unchanged, including documented failure of dopamine-blocking agent reduction for tardive dyskinesia and confirmed Huntington's disease diagnosis for chorea treatment.
Action Required
Before submitting claims for Austedo or Austedo XR: (1) Billing team must verify prior authorization is obtained before claim submission for all Medicare Advantage members. (2) Prior authorization team must confirm member meets clinical criteria: For tardive dyskinesia—documented dopamine receptor-blocking agent use with symptoms persisting despite discontinuation/dose reduction OR documented medical reason discontinuation is not possible, OR tardive dyskinesia unrelated to other medications; for Huntington's disease—confirmed genetic diagnosis of chorea associated with Huntington's disease. (3) Update internal prior auth tracking system to reflect approval duration as plan year for both initial and renewal requests. (4) Ensure providers document CYP2D6 metabolizer status and concurrent medications (avoid reserpine, MAOIs, tetrabenazine, valbenazine) before dispensing. (5) Flag any claims lacking prior authorization—they will be denied. Note: This is a routine policy revision with no substantive coverage changes from prior versions.