Medicare AdvantagePrior AuthMedium impact
Revatio® (sildenafil) oral tab (Revised)
Humana·Cardiology, Pulmonology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Revatio (sildenafil) oral tablet prior authorization policy effective January 1, 2021, with the most recent revision dated December 17, 2025. The policy requires prior authorization for brand Revatio only when members have failed, are contraindicated to, or are intolerant of generic sildenafil or generic tadalafil (Adcirca), and requires confirmation of pulmonary arterial hypertension (WHO Group I) by right heart catheterization. This is a maintenance revision of an existing policy with no substantive coverage changes.
Action Required
Before January 1, 2026 (or immediately if not already implemented): Billing and prior authorization teams must verify that the Revatio prior authorization workflow reflects the current December 17, 2025 revision. Specifically: (1) Update PA request templates to require documentation of prior therapy failure, contraindication, or intolerance to BOTH generic sildenafil AND generic tadalafil (Adcirca) before approving brand Revatio; (2) Ensure PA requests include confirmation of WHO Group I PAH diagnosis documented by right heart catheterization; (3) Update clinical decision support in billing software to route Revatio claims to PA queue; (4) Train PA staff and providers that generic alternatives must be exhausted first for Medicare Advantage members. Check Humana's online policy portal to confirm this is the current version before processing claims. Failure to obtain prior authorization will result in claim denials for brand Revatio.