Medicare AdvantagePrior AuthMedium impact
Afrezza® (insulin human) Inhalation Powder (Revised)
Humana·Endocrinology, Internal Medicine, General Practice +1 more·Medicare Advantage
Effective date
Oct 22, 2025
We identified it
Jun 25, 2026
Summary
Humana has revised its Medicare Advantage prior authorization policy for Afrezza (inhaled insulin) effective October 22, 2025. The policy now requires prior authorization for Type 1 and Type 2 diabetes patients, with specific clinical criteria including failed injectable insulin trials, non-smoking status, and exclusion of patients with chronic lung disease. Billing teams must implement prior auth requirements before claims are submitted for this medication.
Action Required
By October 22, 2025: Billing team must update claims processing system to require prior authorization for all Afrezza prescriptions on Medicare Advantage plans. Update pharmacy billing protocols to screen for prior auth before claim submission. Ensure providers submit documentation showing: (1) Type 1 or Type 2 diabetes diagnosis, (2) prior treatment with injectable meal-time insulin (lispro, aspart, glulisine, or regular insulin), (3) HbA1c not at goal after 90+ days of injectable insulin therapy, (4) concurrent use with long-acting insulin for Type 1 patients, (5) metformin trial/contraindication/intolerance for Type 2 patients, and (6) non-smoking status. Add checklist to pharmacy prior auth request forms to capture lung disease screening documentation (spirometry/FEV1). Flag any claims for patients with asthma or COPD as potential denials per black box warning. Claims submitted without prior authorization will be denied. Pharmacy staff should verify smoking status and lung disease history before filling prescriptions.