Medicare AdvantagePrior AuthMedium impact
Triptans (Revised)
Humana·Neurology, Pain Management, Family Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2019
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage step therapy policy for triptan medications (effective January 1, 2019, revised April 22, 2026). The policy requires patients to have a trial with TWO of three generic triptan products (sumatriptan, rizatriptan, or naratriptan) before coverage of branded or alternative triptan formulations. The policy covers 15 triptan products across multiple delivery methods and includes specific contraindications and warnings related to cardiovascular and cerebrovascular conditions.
Action Required
By May 22, 2026 (within 30 days of revision): Billing and clinical teams must verify this is the current version at www.humana.com before processing any triptan prior authorization requests. Update internal documentation to reflect the step therapy requirement: patients requesting branded triptans (Zomig, Relpax, Frova, Onzetra Xsail, Tosymra, Zembrace Symtouch, Treximet, Symbravo, zolmitriptan nasal spray) or combination products must have documented failed trials with at least TWO generic triptans (sumatriptan, rizatriptan, naratriptan). Before submitting prior authorization requests for triptan claims on Humana Medicare Advantage plans, verify patient has met step therapy criteria and obtain documentation of prior generic triptan trials. Flag all triptan requests lacking this documentation for provider outreach. Train billing and authorization staff on contraindications (CAD, stroke history, hemiplegic migraine, uncontrolled hypertension, etc.) to screen for coverage barriers before claim submission. Note: This policy appears incomplete in the provided document (approval duration criteria and specific claim codes are referenced but not fully detailed) - verify complete policy details at the Humana portal before implementation.