Medicare AdvantagePrior AuthMedium impact
Rozerem® (ramelteon) (Revised)
Humana·Psychiatry, Sleep Medicine, Geriatrics +1 more·Medicare Advantage
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Rozerem® (ramelteon) pharmacy coverage policy, effective January 1, 2020, with a revision date of March 25, 2026. The policy implements a step therapy requirement: members must have previous treatment failure, documented contraindication, or documented intolerance to Belsomra or trazodone tablet before Rozerem is approved. Coverage is approved for plan year duration on both initial and renewal requests.
Action Required
By March 25, 2026: Billing and prior authorization teams must implement step therapy verification for all Rozerem (ramelteon) claims submitted under Humana Medicare Advantage plans. When processing Rozerem requests, require documentation showing member has failed, cannot tolerate, or has contraindications to Belsomra or trazodone tablet. Update prior authorization software and denial rules to automatically flag claims missing this documentation. Train providers and clinical staff to submit documentation of prior therapy attempts with all Rozerem authorization requests. Communicate to prescribers that claims will be denied if step therapy criteria are not met. Alert member services team that inquiries about Rozerem coverage should reference the step therapy requirement.