Medicare AdvantagePrior AuthMedium impact
Nuvigil® (armodafinil) (Revised)
Humana·Neurology, Sleep Medicine, Pulmonology +1 more·Medicare Advantage
Effective date
Jan 1, 2018
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Nuvigil (armodafinil) prior authorization policy effective January 1, 2018, with the most recent revision dated November 26, 2025. The policy requires prior authorization for brand Nuvigil requests and mandates documented previous treatment or intolerance to armodafinil or modafinil before approval. Coverage is limited to excessive daytime sleepiness associated with narcolepsy, obstructive sleep apnea, or shift-work sleep disorder.
Action Required
By December 31, 2025: Billing team must update prior authorization procedures to ensure all brand Nuvigil (armodafinil) requests include documented evidence of previous treatment or documented intolerance to armodafinil or modafinil before submission to Humana. Update EMR/billing software templates to capture this documentation requirement on all Nuvigil prescription requests. Providers must document the specific indication (narcolepsy, obstructive sleep apnea, or shift-work sleep disorder) on all prior authorization submissions. Claims submitted without prior authorization or without proof of previous treatment/intolerance will be denied. Front desk and prior authorization staff should verify documentation completeness before submitting to payer.