Medicare AdvantagePrior AuthHigh impact
Multi-Source Brands (Revised)
Humana·Pharmacy, Internal Medicine, Geriatrics +4 more·Medicare Advantage
Effective date
Aug 24, 2007
We identified it
Jun 25, 2026
Summary
Humana revised its Multi-Source Brands pharmacy coverage policy (effective August 24, 2007, with revision date December 17, 2025) to clarify utilization management requirements for brand-name drugs that have lost patent protection. Multi-Source Brand products now require prior authorization review, and coverage is medically necessary only when members have had previous treatment failure, intolerance, or contraindication to an AB-rated generic equivalent. This policy applies to all commercially available strengths and dosage forms, including drugs in the six protected Medicare classes (immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics).
Action Required
Effective immediately: Billing and pharmacy teams must implement prior authorization protocols for all Multi-Source Brand drug requests on Medicare Advantage plans. Specifically: (1) Require documentation from providers that the member has had prior treatment failure, documented intolerance, or contraindication to an AB-rated generic equivalent before approving brand-name coverage; (2) Configure billing/pharmacy system to apply utilization management edits to all strengths and dosage forms of Multi-Source Brand products; (3) For protected class drugs (immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, antineoplastics), enforce the requirement that members complete a reasonable 90-day trial of generic therapy before brand approval is considered (unless clinical reasons for non-adherence are documented); (4) Educate providers and staff that Humana recognizes exceptions to the 90-day trial requirement when members experience adverse drug events, intolerable side effects, or allergic reactions; (5) Refer to Humana's Preauthorization and Notification List (PAL) at www.humana.com/PAL for applicable coding information. Claims for Multi-Source Brands submitted without documented prior generic failure or contraindication will be denied.