Medicare AdvantagePrior AuthMedium impact
Vimovo® (naproxen-esomeprazole magnesium) (Revised)
Humana·Rheumatology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated the Vimovo (naproxen-esomeprazole magnesium) prior authorization policy effective January 28, 2026. The policy requires prior authorization for all Vimovo prescriptions and mandates that patients must have prior treatment with two combinations of prescription-strength NSAID plus PPI before approval. Patients must be 12+ years old, weigh at least 38 kg, and have one of four specified arthritis diagnoses.
Action Required
By January 28, 2026: Billing team must implement prior authorization requirement for all Vimovo prescriptions (naproxen-esomeprazole magnesium, all strengths). Update billing system rules to: (1) Flag all Vimovo claims requiring prior authorization before submission; (2) Configure system to verify patient age ≥12 years and weight ≥38 kg; (3) Document in patient chart verification of prior NSAID+PPI combination therapy (minimum 2 different combinations required); (4) Confirm diagnosis is limited to rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, or juvenile idiopathic arthritis (JIA). Providers must document prior NSAID+PPI treatment history on all Vimovo authorization requests. Train front desk and clinical staff on new eligibility criteria. Claims submitted without prior authorization or missing required documentation will be denied. Contact Humana PAL system at www.humana.com/PAL for specific authorization procedures and claim codes.