Medicare AdvantagePrior AuthMedium impact
Tyrvaya® (varenicline) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jul 2, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Tyrvaya (varenicline) nasal spray for dry eye disease treatment. The policy now requires prior authorization and mandates that members must have failed or be intolerant to cyclosporine eye drops (Restasis) AND at least one of three alternative treatments (Eysuvis, Miebo, or Tryptyr) before Tyrvaya is approved. This represents a restrictive step-therapy requirement that will impact prescription approvals.
Action Required
Before January 1, 2025: Billing and clinical teams must implement prior authorization process for all Tyrvaya prescriptions submitted to Humana Medicare Advantage plans. Update billing software and pharmacy systems to flag Tyrvaya claims requiring prior auth submission. Providers must document patient's failed or contraindicated use of cyclosporine eye drops (Restasis) AND failure or intolerance to at least one of: Eysuvis, Miebo, or Tryptyr in medical records before submitting prior auth requests to Humana. Add verification step in pharmacy workflow to confirm step-therapy requirements are met before processing. Failure to obtain prior authorization or meet step-therapy criteria will result in claim denials and delayed patient access to medication.