Medicare AdvantagePrior AuthMedium impact
Exservan™ (riluzole) (Revised)
Humana·Neurology, Palliative Care·Medicare Advantage
Effective date
Aug 18, 2021
We identified it
Jun 25, 2026
Summary
Humana updated its Exservan (riluzole) oral film prior authorization policy for Medicare Advantage members with ALS, effective August 18, 2021 with a revision date of June 24, 2026. The policy requires prior authorization for Exservan and mandates that members must have previous riluzole tablet treatment AND a documented contraindication to tablets (such as impaired swallowing ability) to qualify for coverage of the oral film formulation.
Action Required
Before submitting Exservan claims: Billing team must verify that member has BOTH (1) documented prior treatment with riluzole tablets AND (2) documented contraindication to riluzole tablets (e.g., dysphagia/impaired swallowing). Do not submit claims without prior authorization. Update prior authorization submission checklist to require evidence of previous riluzole therapy and specific contraindication documentation from the prescribing provider. Rejection of claims will occur if both criteria are not met. Coordinate with providers to ensure clinical notes document the contraindication clearly before claim submission.