CommercialPrior AuthHigh impact
EpiPen® and EpiPen Jr® (epinephrine) (Revised)
Humana·Pharmacy, Allergy & Immunology, Emergency Medicine +1 more·Commercial
Effective date
Jan 24, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its EpiPen/EpiPen Jr pharmacy coverage policy effective January 24, 2024, implementing a step therapy requirement. Members must have prior treatment with generic epinephrine auto-injectors or Symjepi before coverage of brand-name EpiPen products is approved. This is a coverage restriction that will require prior authorization for affected claims.
Action Required
By February 15, 2024: Billing team must implement prior authorization workflow for all EpiPen and EpiPen Jr claims submitted to Humana Commercial plans. Specifically: (1) Update billing system to require documentation of prior generic epinephrine or Symjepi treatment before authorizing brand-name EpiPen products; (2) Create verification checklist for pharmacy/prior auth staff to confirm member meets step therapy criteria; (3) Train clinical staff to verify treatment history at point of service; (4) Update claim submission protocols to include step therapy compliance documentation. Reference Humana's TAD portal (http://apps.humana.com/tad/tad_new/home.aspx) for current policy version before processing each claim. Claims submitted without evidence of prior generic epinephrine treatment will be denied.