Medicare AdvantagePrior AuthMedium impact
Bisphosphonates (Revised)
Humana·Endocrinology, Geriatrics, Rheumatology +1 more·Medicare Advantage
Effective date
Jan 1, 2017
We identified it
Jun 25, 2026
Summary
Humana has revised its Bisphosphonates (Binosto, Fosamax, Fosamax Plus D) pharmacy coverage policy for Medicare Advantage, effective January 1, 2017, with the most recent revision dated February 25, 2026. This is a Step Therapy policy requiring members to have previous treatment or intolerance to alendronate before approval. The policy includes extensive contraindications and cautions regarding patient eligibility, including restrictions for severe renal insufficiency, GI abnormalities, hypocalcemia, and conditions increasing osteonecrosis of the jaw risk.
Action Required
By March 15, 2026: Billing and clinical teams must implement the revised Step Therapy requirement for all Humana Medicare Advantage bisphosphonate claims. Specifically: (1) Update prior authorization protocols to require documentation of previous alendronate treatment or documented intolerance before approving Binosto, Fosamax, or Fosamax Plus D; (2) Educate providers to verify member eligibility against contraindications (severe renal insufficiency, active GI problems, hypocalcemia, inability to remain upright 30 minutes, esophageal abnormalities) on encounter forms and prior auth submissions; (3) Flag claims lacking step therapy documentation for denial or return to provider for additional documentation; (4) Ensure prior authorization system reflects all three affected medications and their formulation variants (70mg tablets, 70mg/2800IU, 70mg/5600IU). Failure to obtain proper step therapy authorization will result in claim denials for Humana Medicare Advantage members.