Medicare AdvantagePrior AuthMedium impact
Osmolex ER™ (amantadine extended release) (Revised)
Humana·Neurology, Psychiatry, Geriatrics +1 more·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana updated its Osmolex ER (amantadine extended release) prior authorization policy for Medicare Advantage members on November 26, 2025. The policy requires prior authorization for coverage of Osmolex ER in two indications: Parkinson's disease and drug-induced extrapyramidal reactions. For both conditions, members must demonstrate tolerance to at least 100mg of immediate-release amantadine and inadequate symptom improvement on immediate-release amantadine before the extended-release formulation will be approved.
Action Required
By December 26, 2025: Billing and clinical staff must implement prior authorization requirements for Osmolex ER prescriptions for all Medicare Advantage members. (1) Update billing system to flag all Osmolex ER claims requiring prior authorization; (2) Ensure providers submit prior auth requests documenting: member diagnosis (Parkinson's disease OR drug-induced extrapyramidal reactions), tolerance to ≥100mg immediate-release amantadine, and evidence of inadequate symptom improvement on immediate-release amantadine. For drug-induced extrapyramidal reactions, also document that offending agent dose reduction/discontinuation was unsuccessful or not feasible; (3) Add Osmolex ER to prior authorization checklist in EMR and billing software; (4) Train front desk and billing staff to identify Osmolex ER claims requiring auth before submission. Claims submitted without required prior authorization documentation will be denied. Reference policy source: https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a45507f