Medicare AdvantagePrior AuthMedium impact
Nuedexta® (dextromethorphan and quinidine) (Revised)
Humana·Neurology, Internal Medicine, Palliative Care·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
This is a revised Medicare Advantage prior authorization policy for Nuedexta (dextromethorphan/quinidine) for treating Pseudobulbar Affect (PBA). The policy requires prior authorization and confirms four approval criteria: diagnosed PBA from neurologic disease, characteristic behavioral episodes, age 18+, and provider attestation that QT prolongation risks are outweighed by treatment benefits. No significant changes from the original policy are documented—this appears to be a routine review/revision update.
Action Required
Billing team must ensure all Nuedexta (dextromethorphan/quinidine) claims for Medicare Advantage members include prior authorization before dispensing. Verify that the patient meets all four criteria: (1) diagnosed PBA from stroke, MS, ALS, Parkinson's, or traumatic brain injury; (2) characteristic laughing/crying episodes; (3) age 18+; and (4) provider attestation of QT risk-benefit assessment. Update prior authorization submission templates and provider order entry systems to flag Nuedexta for mandatory prior auth on Medicare Advantage plans. Communicate to prescribing providers that claims will be denied if prior authorization is not obtained before dispensing. For medically billed requests, direct providers to www.humana.com/PAL for applicable preauthorization codes.