Medicare AdvantagePrior AuthMedium impact
Rayos® (prednisone delayed-release) (Revised)
Humana·Pharmacy, Dermatology, Rheumatology +9 more·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Rayos (prednisone delayed-release) prior authorization policy effective January 1, 2022, with the most recent revision on February 25, 2026. The policy maintains two key approval criteria: (1) Rayos must be used for anti-inflammatory/immunosuppressive treatment of specific conditions, and (2) members must have prior treatment history with both prednisone immediate-release AND at least one other generic corticosteroid. Prior authorization is required for all Rayos prescriptions, with approval granted for plan year durations or as determined through clinical review.
Action Required
Before submitting any Rayos (prednisone delayed-release) claims: Billing team must verify prior authorization has been obtained from Humana before dispensing or billing. When processing Rayos requests, confirm member documentation shows prior treatment with prednisone immediate-release AND at least one other generic corticosteroid (e.g., dexamethasone, methylprednisolone, prednisolone). For initial requests, submit prior auth requests with member treatment history; for renewals, submit before plan year end or at clinical review intervals. Update pharmacy billing system to flag Rayos prescriptions as requiring prior authorization for Medicare Advantage plans. Failure to obtain prior authorization will result in claim denials. Front desk and pharmacy staff should direct providers to submit prior auth requests with documented corticosteroid treatment history before dispensing.