Medicare AdvantagePrior AuthMedium impact
Fetzima® (levomilnacipran) (Revised)
Humana·Psychiatry, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Fetzima (levomilnacipran) prior authorization policy effective August 27, 2025. The policy now requires documentation of prior therapy, intolerance, or contraindication to specific antidepressants (SNRIs, generic bupropion, or mirtazapine) before Fetzima can be approved for Major Depressive Disorder treatment. This is a step-therapy requirement that may delay patient access and requires prior authorization submission with documented evidence of failed or contraindicated prior treatments.
Action Required
By August 27, 2025: Billing and clinical staff must implement prior authorization process for all Fetzima prescriptions under Humana Medicare Advantage plans. (1) Update billing software to flag all Fetzima claims as requiring prior authorization before submission. (2) Create or update patient authorization forms to require providers to document patient history with at least one of the following: SNRIs (duloxetine, venlafaxine, desvenlafaxine ER), generic bupropion (IR, SR, or XL formulations), or mirtazapine—including evidence of intolerance, contraindication, or treatment failure. (3) Train clinical and billing staff on the step-therapy requirement. (4) Update EMR templates to prompt providers to document prior antidepressant therapy. (5) Contact Humana at www.humana.com/PAL for specific claim code submission requirements. Failure to obtain prior authorization or submit required documentation will result in claim denials and delayed patient access to medication.