Medicare AdvantagePrior AuthMedium impact
Northera® (droxidopa) (Revised)
Humana·Neurology, Geriatrics, Internal Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2018
We identified it
Jun 25, 2026
Summary
Humana has revised its Northera® (droxidopa) prior authorization policy effective January 1, 2018, with the most recent revision dated November 26, 2025. The policy requires prior authorization for droxidopa/Northera when treating neurogenic orthostatic hypotension (NOH), with mandatory criteria including diagnosis confirmation and documented failure or intolerance to fludrocortisone or midodrine. This is a routine policy refresh with no substantive coverage changes indicated.
Action Required
By December 31, 2025: Verify this policy is loaded in your prior authorization system for all Medicare Advantage claims involving Northera (droxidopa) in any formulation (100mg, 200mg, 300mg capsules). Billing team must confirm that: (1) Prior authorization is required before claims are submitted; (2) Claim denials are triggered if PA is not obtained; (3) Provider documentation includes diagnosis (PD, MSA, PAF, DBH deficiency, or non-diabetic neuropathy) and evidence of prior treatment failure/intolerance/contraindication to fludrocortisone or midodrine. Before submitting any Northera claim, front desk/billing staff must verify the member's supine blood pressure has been monitored per black box warning requirements. Update internal guidelines to reflect the November 26, 2025 revision date. Reference Humana's online Medical and Pharmacy Coverage Policies portal at www.humana.com/PAL to confirm this remains the current version before processing claims. Claims submitted without prior authorization will be denied.