CommercialPrior AuthMedium impact
BPH Agents (Revised)
Humana·Urology, Internal Medicine, General Practice +1 more·Commercial
Effective date
Apr 24, 2024
We identified it
Jun 25, 2026
Summary
Humana has revised its BPH Agents step therapy policy (effective January 1, 2016, revised April 24, 2024). This is a step therapy policy requiring members to have prior treatment, contraindication, or intolerance with alpha-blockers (doxazosin, terazosin, alfuzosin, tamsulosin) OR finasteride before approval for Avodart, Jalyn, Rapaflo, dutasteride-tamsulosin ER, Entadfi, or silodosin. The policy specifies approval duration as initial plan year duration with no additional detail provided on renewal criteria.
Action Required
Before April 24, 2024: Billing and prior authorization teams must implement step therapy requirements for all BPH agent prescriptions on Humana Commercial plans. Specifically: (1) Update prior authorization system to require evidence of prior treatment, contraindication, or documented intolerance to alpha-blockers (doxazosin, terazosin, alfuzosin, tamsulosin) OR finasteride before approving claims for Avodart (dutasteride), Jalyn (dutasteride-tamsulosin ER), Rapaflo (silodosin), generic dutasteride-tamsulosin ER, Entadfi (finasteride-tadalafil), or generic silodosin; (2) Instruct providers to document prior medication trials or contraindications in authorization requests; (3) Train front desk and authorization staff to collect this clinical history at time of authorization request; (4) Verify Humana's current policy version at http://apps.humana.com/tad/tad_new/home.aspx before processing any authorization. Claims submitted without evidence of prior alpha-blocker or finasteride therapy will be denied. Note: This policy revision date is 1 day old—monitor for any implementation updates from Humana.