CommercialPrior AuthMedium impact
Dopamine Agonists (Revised)
Humana·Neurology, Geriatrics·Commercial
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana's Dopamine Agonists policy (Mirapex ER, pramipexole ER, ropinirole ER) was revised on June 26, 2024, and remains a step therapy requiring members to try or be unable to use immediate-release formulations (pramipexole IR and ropinirole IR) before approval for extended-release versions. This is a commercial plan policy affecting Parkinson's disease treatment. The policy confirms step therapy requirements but does not appear to introduce new restrictions beyond the original January 1, 2021 effective date.
Action Required
Immediately review all pending and recent claims for Mirapex ER, pramipexole ER tablet extended-release 24hr, and ropinirole ER tablet extended-release 24hr. Verify that prior authorization documentation includes evidence that members have tried or cannot use pramipexole immediate-release tablets AND ropinirole immediate-release tablets. For claims submitted without step therapy verification, resubmit with required documentation or obtain retroactive prior authorization from Humana. Update your billing system and clinical staff guidance to enforce the step therapy requirement: Billing team must confirm step therapy criteria are met before submitting claims for these extended-release formulations to Humana commercial plans. Failure to meet step therapy criteria will result in claim denials. Reference current policy version at http://apps.humana.com/tad/tad_new/home.aspx to verify no further changes have occurred since June 26, 2024.