Medicare AdvantagePrior AuthMedium impact
BiDil® (isosorbide dinitrate/hydralazine) (Revised)
Humana·Cardiology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana revised its BiDil® (isosorbide dinitrate/hydralazine) prior authorization policy effective January 1, 2022, with the most recent revision dated April 22, 2026. The policy requires prior authorization for BiDil tablet coverage in Medicare Advantage members with NYHA Class II-IV heart failure who have prior therapy with isosorbide dinitrate combined with hydralazine. Billing teams must ensure all BiDil claims include documented prior authorization and meet the two clinical criteria before submission.
Action Required
Immediately: Billing team must implement prior authorization requirement for all BiDil® (isosorbide dinitrate/hydralazine) tablet prescriptions for Medicare Advantage members. (1) Update billing software to flag all BiDil claims for prior authorization review before processing. (2) Create or update prior authorization request template to require documentation of: (a) NYHA Class II-IV heart failure diagnosis with supporting clinical notes, and (b) evidence of prior therapy using isosorbide dinitrate in combination with hydralazine. (3) Train billing and authorization staff that both criteria must be met; claims lacking this documentation will be denied. (4) Direct providers to include both clinical criteria documentation with all BiDil prescriptions submitted for authorization. (5) Verify current version of policy on Humana's website before processing each claim, as policy is updated regularly. Claims submitted without prior authorization or missing required clinical documentation will be denied and may require resubmission.