CommercialPrior AuthLow impact
Dronabinol containing products (BRAND) (Revised)
Humana·Oncology, Infectious Disease, Pharmacy +1 more·Commercial
Effective date
Aug 28, 2024
We identified it
Jun 25, 2026
Summary
Humana updated its Dronabinol (Marinol/Syndros) prior authorization policy effective August 28, 2024. The policy maintains two coverage pathways: AIDS-related anorexia (requiring trials of megestrol acetate and generic dronabinol first) and chemotherapy-induced nausea/vomiting (requiring trials of generic dronabinol and another antiemetic agent first). This is a routine policy revision with no substantive changes to coverage criteria or billing requirements.
Action Required
By September 30, 2024: Billing and prior authorization teams should review the updated policy document at http://apps.humana.com/tad/tad_new/home.aspx to confirm current version. No immediate workflow changes are required. When processing Marinol or Syndros requests from Humana Commercial plans, ensure prior authorization documentation includes: (1) for AIDS anorexia cases—evidence of trial/intolerance/contraindication to megestrol acetate AND generic dronabinol; (2) for CINV cases—evidence of trial/intolerance to generic dronabinol AND another antiemetic (e.g., ondansetron, prochlorperazine). Update internal reference materials to reflect August 28, 2024 as the current policy date to avoid using outdated printed versions. No claims impact is anticipated as criteria remain unchanged from prior versions.