Medicare AdvantagePrior AuthLow impact
Cayston® (aztreonam inhalation solution) (Revised)
Humana·Pulmonology, Pediatrics, Infectious Disease·Medicare Advantage
Effective date
Jan 1, 2019
We identified it
Jun 25, 2026
Summary
Humana updated its Cayston® (aztreonam inhalation solution) prior authorization policy effective January 1, 2019, with a revision date of December 17, 2025. This is a Medicare Advantage pharmacy coverage policy requiring prior authorization for Cayston in cystic fibrosis patients colonized with Pseudomonas aeruginosa. The policy maintains three approval criteria and two exclusionary criteria, with no apparent changes to clinical requirements from the original effective date.
Action Required
This policy revision is informational. The billing team should verify this is the current version by visiting the Humana Medical and Pharmacy Coverage Policies portal. No immediate action is required unless your practice recently submitted Cayston claims that were denied. If claims were denied, resubmit with documentation confirming: (1) CF diagnosis, (2) Pseudomonas aeruginosa colonization, (3) FEV1 between 25-75% predicted, (4) no Burkholderia cepacia colonization, and (5) concurrent short- or long-acting beta-agonist use. Ensure prior authorization is obtained before dispensing Cayston to Medicare Advantage members. Update internal policy files to reference the December 17, 2025 revision date to avoid relying on outdated printed versions.