Medicare AdvantagePrior AuthMedium impact
Provigil® (modafinil) (Revised)
Humana·Sleep Medicine, Neurology, Pulmonology +1 more·Medicare Advantage
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Provigil (modafinil) prior authorization policy on November 26, 2025. The policy maintains coverage for excessive daytime sleepiness associated with narcolepsy, obstructive sleep apnea, and shift-work sleep disorder, plus Steinert myotonic dystrophy syndrome, but requires prior authorization and documentation of previous treatment, intolerance, or contraindication to armodafinil or modafinil before approval.
Action Required
By December 26, 2025: Billing and prior authorization staff must review and implement the updated Provigil (modafinil) prior authorization requirements for all Medicare Advantage members. Providers must document in patient records: (1) diagnosis of narcolepsy, obstructive sleep apnea, shift-work sleep disorder, OR Steinert myotonic dystrophy syndrome; (2) evidence of previous treatment with armodafinil or modafinil, OR documented intolerance/contraindication to these agents. Update prior authorization submission templates and intake forms to capture this documentation. All Provigil requests for Medicare Advantage members must include these criteria or claims will be denied. Train front-desk and clinical staff to alert providers when prior authorization is needed before dispensing.