Medicare AdvantagePrior AuthMedium impact
Voquezna® (vonoprazan) (Revised)
Humana·Gastroenterology, Internal Medicine·Medicare Advantage
We identified it
Jul 23, 2026
Summary
Humana has issued a revised Prior Authorization policy for Voquezna® (vonoprazan), a gastric acid suppressant medication for Medicare Advantage members. This is a policy update to existing prior authorization requirements; billing teams must verify current authorization thresholds and documentation requirements to avoid claim denials.
Action Required
Immediately: Obtain the complete policy details from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867f4) as only a summary is currently available. Billing team must: (1) Identify the HCPCS code for vonoprazan/Voquezna® (likely J9999 or similar); (2) Update prior authorization workflows to reflect any revised requirements; (3) Notify prescribing providers of new or changed authorization criteria; (4) Update billing system rules to flag Voquezna® claims for prior authorization verification before submission. Failure to obtain prior authorization will result in claim denials. This policy is 1 day old and takes priority over any older vonoprazan authorization guidance.