Medicare AdvantagePrior AuthMedium impact
Tiglutik® (riluzole) (Revised)
Humana·Neurology, Pharmacy, Palliative Care·Medicare Advantage
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Tiglutik (riluzole) oral suspension prior authorization policy effective June 24, 2026. The policy requires prior authorization for Medicare Advantage members with ALS who have previously failed riluzole tablets AND have a documented contraindication (such as impaired swallowing ability). This is a restrictive criteria requiring documented prior tablet use and specific contraindication before approval.
Action Required
By June 24, 2026: Billing team must implement prior authorization requirement for Tiglutik (riluzole) oral suspension claims from Medicare Advantage members. Update billing system to flag all Tiglutik claims for prior auth review. Ensure providers document (1) ALS diagnosis, (2) prior treatment with riluzole tablets, and (3) specific contraindication to tablets (e.g., dysphagia/swallowing impairment) in the prior auth request. Pharmacy staff should verify member meets all two criteria before submitting claims. Claims submitted without documented prior tablet failure and contraindication will be denied. Reference Humana's PAL (Preauthorization and Notification List) at www.humana.com/PAL for current claim code requirements.