Medicare AdvantagePrior AuthMedium impact
Dihydroergotamine Products (Revised)
Humana·Neurology, Pain Management, Emergency Medicine·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Dihydroergotamine Products prior authorization policy (effective 1/1/2022, revised 9/24/2025). The policy requires prior authorization for dihydroergotamine nasal spray and injection for acute migraine treatment. Prior to approval, members must demonstrate previous treatment, intolerance, or contraindication to at least TWO of four specified first-line agents (naproxen, naratriptan, rizatriptan, or sumatriptan). Approvals are granted for the plan year duration with annual renewal options.
Action Required
Immediately: Billing team must implement prior authorization requirement for all dihydroergotamine nasal spray and injection claims submitted to Humana Medicare Advantage plans. Before submitting claims, verify that patient documentation includes evidence of previous treatment failure, intolerance, or contraindication to TWO of the following agents: naproxen tablet, naratriptan tablet, rizatriptan tablet, or sumatriptan tablet. Update billing software templates and claim submission workflows to flag dihydroergotamine requests for prior authorization review. Instruct providers to document the specific failed first-line agents and clinical rationale in patient records. Note: The policy revision date is 9/24/2025 (1 day old); verify this is the active version on www.humana.com/PAL before processing claims. Claims submitted without required prior authorization or incomplete first-line agent documentation will be denied.