Medicare AdvantagePrior AuthMedium impact
Ophthalmic Cyclosporine (Cequa®, Restasis®, Restasis MultiDose®, Vevye®) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
We identified it
Jul 2, 2026
Summary
This is a revised Prior Authorization policy for ophthalmic cyclosporine medications (Cequa®, Restasis®, Restasis MultiDose®, Vevye®) affecting Medicare Advantage members. The policy update was issued 1 day ago and requires billing teams to verify prior authorization requirements have been updated in their systems for these ophthalmic agents.
Action Required
Immediately: Billing and clinical teams must review the complete revised policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5b4 to identify specific prior authorization requirements, approval criteria, and any changes from the previous policy version. Update intake processes, encounter forms, and billing system rules to reflect new PA requirements for ophthalmic cyclosporine prescriptions. Contact Humana Medicare Advantage for specific effective date and implementation details if not provided in full policy document. Claims submitted without required prior authorization will be denied. Front-desk and clinical staff should be notified of any new documentation or authorization steps required at the point of service.