Medicare AdvantagePrior AuthMedium impact
Ingrezza® & Ingrezza Sprinkle (valbenazine) (Revised)
Humana·Neurology, Psychiatry, Pharmacy·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Ingrezza (valbenazine) prior authorization policy for Medicare Advantage members effective August 27, 2025. The revised policy maintains prior auth requirements for two indications: tardive dyskinesia (with mandatory prior treatment/contraindication/intolerance to Austedo) and chorea associated with Huntington's disease (with same Austedo requirement). Key clinical additions include Black Box Warning language for depression/suicidal ideation risk in Huntington's disease patients and expanded warnings/precautions documentation.
Action Required
By August 27, 2025: Billing and clinical teams must update prior authorization workflows for Ingrezza/Ingrezza Sprinkle requests to ensure all Medicare Advantage members meet BOTH criteria: (1) confirmed diagnosis of tardive dyskinesia with documented dopamine blocker discontinuation/reduction attempts OR moderate-severe non-dopamine-associated TD, OR Huntington's disease chorea diagnosis; AND (2) documented previous treatment with, contraindication, or intolerance to Austedo/Austedo XR. Update PA request forms to require Austedo failure/contraindication documentation. Flag prescriptions lacking Austedo history for denial. Providers must document Black Box Warning acknowledgment for Huntington's disease cases (depression/suicidal risk counseling). Clinical staff should review the expanded warnings section for monitoring requirements (somnolence, QT prolongation, NMS, parkinsonism) and ensure provider ordering reflects dose adjustments for hepatic impairment, CYP2D6 poor metabolizers, and drug interactions. Failure to obtain complete prior authorization documentation will result in claim denials.