Medicare AdvantagePrior AuthMedium impact
Desmopressin Nasal Spray (Revised)
Humana·Endocrinology, Pediatrics, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Desmopressin Nasal Spray prior authorization policy (revision dated April 24, 2024). The policy requires prior authorization for desmopressin nasal spray with one key criterion: members must have had previous treatment or intolerance with generic desmopressin tablets. Approval is granted for the initial plan year duration. This is a refreshed policy document with the same effective date (January 1, 2022) but recent clinical review.
Action Required
Before prescribing or billing desmopressin nasal spray for Medicare Advantage members: (1) Billing team must verify prior authorization is obtained through Humana's PAL system (www.humana.com/PAL) before claims submission; (2) Verify member documentation shows previous treatment or intolerance with generic desmopressin tablets to meet coverage criteria; (3) Update claim submission workflows to require prior auth flag for desmopressin nasal spray (non-refrigerated and standard formulations); (4) Educate providers that claims submitted without prior authorization will be denied. Note: The policy document references accessing medical billing codes through www.humana.com/PAL—billing team should confirm current approval status there before each submission.