Medicare AdvantagePrior AuthMedium impact
XHANCE® (fluticasone propionate) (Revised)
Humana·ENT (Ear, Nose & Throat), Allergy & Immunology, Family Medicine +1 more·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana updated its XHANCE (fluticasone propionate) prior authorization policy effective April 22, 2026. For CRSwNP (with nasal polyps), members now require documentation of previous treatment/contraindication/intolerance with TWO of three specific intranasal products (fluticasone propionate, mometasone, Qnasl) before approval. For CRSsNP (without nasal polyps), only a diagnosis of chronic rhinosinusitis without nasal polyps is required. This revision clarifies coverage criteria and tightens authorization requirements for the nasal spray therapy.
Action Required
By April 22, 2026: Billing and authorization teams must update prior authorization workflows for XHANCE (fluticasone propionate) in the Humana Medicare Advantage system. (1) For CRSwNP claims: Require providers to document that members have had previous treatment attempts, contraindications, or intolerances with at least TWO of the following: fluticasone propionate, mometasone, or Qnasl before submitting authorization requests. (2) For CRSsNP claims: Only require documentation of chronic rhinosinusitis diagnosis without nasal polyps. (3) Update prior authorization forms and denial templates to reflect these new criteria. (4) Train authorization staff on the two-tier approval criteria. Failure to obtain required prior authorization documentation will result in claim denials. Contact Humana PAL portal at www.humana.com/PAL for updated claim codes and documentation requirements.