Medicare AdvantagePrior AuthLow impact
Xenazine® (tetrabenazine) (Revised)
Humana·Neurology, Psychiatry·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana revised its Xenazine (tetrabenazine) pharmacy coverage policy for Medicare Advantage members with a revision date of June 24, 2026. The policy maintains prior authorization requirements for brand Xenazine when members have not previously tried or are intolerant to generic tetrabenazine. No substantive coverage criteria changes are documented in this revision; the policy continues to cover tetrabenazine for chorea associated with Huntington's disease with the same clinical and safety requirements.
Action Required
No immediate billing workflow changes required. However, billing staff should: (1) Verify this is the current policy version on Humana's website before processing Xenazine/tetrabenazine claims; (2) When prior authorization is requested for brand Xenazine, confirm documentation shows member's previous treatment with or documented intolerance to generic tetrabenazine; (3) Flag any claims for doses exceeding 50 mg/day that lack CYP2D6 metabolizer testing documentation, as this testing is required per policy before prescribing above this threshold; (4) Route claims to medical director review if member has active depression, suicidality, hepatic impairment, or concurrent MAOI/reserpine/deutetrabenazine/valbenazine use, as these are contraindications.