Medicare AdvantagePrior AuthMedium impact
Tadalafil Products - PAH Indication Only (Revised)
Humana·Pulmonology, Cardiology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for tadalafil products (Adcirca, Alyq, Tadliq) for pulmonary arterial hypertension treatment, effective January 1, 2021, with the most recent revision dated May 27, 2026. The policy requires members to have confirmed PAH diagnosis via right heart catheterization and, for brand Adcirca specifically, prior therapy failure or contraindication/intolerance to sildenafil or generic tadalafil. Prior authorization is mandatory for all tadalafil PAH products under this plan.
Action Required
REQUIREMENTS: Effective immediately (policy revision dated May 27, 2026): Billing team must verify that all tadalafil/Adcirca/Alyq/Tadliq claims for Humana Medicare Advantage members include prior authorization. Before submitting claims, confirm member documentation shows: (1) Confirmed PAH diagnosis documented via right heart catheterization; and (2) For brand Adcirca claims only, evidence of prior therapy with sildenafil (generic Revatio) or generic tadalafil (generic Adcirca), OR documented contraindication or intolerance to these agents. Update claim submission workflows to require prior auth verification through Humana's preauthorization system before billing. Refer providers to www.humana.com/PAL for specific medical billing request procedures and applicable coding information. Claims submitted without proper prior authorization or missing required medical documentation will be denied by Humana.