Medicare AdvantagePrior AuthMedium impact
Trintellix (vortioxetine) (Revised)
Humana·Psychiatry, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its Trintellix (vortioxetine) Medicare Advantage pharmacy coverage policy effective June 24, 2026. The policy maintains step therapy requirements: automatic approval is granted only to members with documented prior therapy, intolerance, or contraindication to at least one first-line antidepressant (SSRIs, SNRIs, bupropion, or mirtazapine). Billing teams must ensure prior authorization requests include evidence of failed or contraindicated first-line therapy before dispensing.
Action Required
By June 24, 2026: Billing and pharmacy teams must update authorization protocols to enforce step therapy for Trintellix. Specifically: (1) Before approving any Trintellix claim, pharmacy staff must verify member has documented trial, intolerance, or contraindication to at least one of: generic SSRIs (citalopram, fluoxetine, paroxetine, sertraline), generic SNRIs (venlafaxine, duloxetine), generic bupropion (75mg/100mg IR, 100mg/150mg/200mg SR, or 150mg/300mg XL), or mirtazapine. (2) Update prior authorization forms and EMR templates to require providers to document which first-line agent(s) were tried and why Trintellix is medically necessary. (3) Configure billing system to auto-deny Trintellix claims without documented step therapy evidence. (4) Train front-line staff to request required documentation from prescribers before processing. Failure to enforce step therapy will result in automatic claim denials and patient out-of-pocket costs. Note: This is a revision of an existing policy; verify no superseding guidance exists after June 24, 2026.