CommercialPrior AuthMedium impact
Namzaric® (memantine and donepezil extended release) (Revised)
Humana·Neurology, Geriatrics, Pharmacy·Commercial
Effective date
Jan 24, 2024
We identified it
Jun 25, 2026
Summary
Humana revised its Namzaric (memantine/donepezil) prior authorization policy effective January 24, 2024. The policy requires prior authorization for Namzaric coverage and mandates that members have confirmed moderate-to-severe Alzheimer's dementia AND prior treatment with both memantine AND donepezil individually before approval. Billing teams must verify both criteria are documented before submitting claims to avoid denial.
Action Required
By February 15, 2024: Billing and authorization staff must update prior authorization workflows to enforce BOTH eligibility criteria: (1) confirmed moderate-to-severe Alzheimer's dementia diagnosis, AND (2) documented prior treatment history with memantine AND donepezil separately. Before submitting any Namzaric claim for commercial Humana plans, verify in member records that both individual medications were previously prescribed. Update pre-authorization checklist forms to require explicit documentation of prior memantine and donepezil use. Train providers and front desk staff to confirm this history during prior auth requests. Failure to obtain prior authorization or meet eligibility criteria will result in claim denials. Contact Humana PAL system (www.humana.com/PAL) for medically-billed requests. Verify current policy version at http://apps.humana.com/tad/tad_new/home.aspx before processing.