Medicare AdvantagePrior AuthMedium impact
Gimoti™ (metoclopramide) (Revised)
Humana·Gastroenterology, Endocrinology, Internal Medicine +1 more·Medicare Advantage
Effective date
Aug 27, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its prior authorization policy for Gimoti (metoclopramide nasal spray) on August 27, 2025. The policy requires prior authorization for Gimoti coverage in Medicare Advantage members with diabetic gastroparesis who have failed or are intolerant to generic metoclopramide. Billing teams must verify all Gimoti claims meet the two approval criteria and confirm members have no history of tardive dyskinesia or dystonic reactions before submission.
Action Required
By September 10, 2025: Billing team must implement prior authorization requirement for all Gimoti (metoclopramide nasal spray) claims submitted to Humana Medicare Advantage plans. Before each claim submission: (1) Verify member has documented diagnosis of diabetic gastroparesis, (2) Confirm previous treatment failure or documented intolerance with generic metoclopramide (tablet or solution form), (3) Review member chart for contraindications including history of tardive dyskinesia or dystonic reactions to metoclopramide, (4) Submit prior authorization request through Humana's PAL system (www.humana.com/PAL) before dispensing. Update billing software to flag all Gimoti prescriptions for mandatory prior auth review. Educate providers that claims submitted without prior authorization will be denied and require resubmission, delaying member access to medication.