Medicare AdvantagePrior AuthMedium impact
Nuedexta® (dextromethorphan and quinidine) (Revised)
Humana·Neurology, Psychiatry, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Aug 5, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Nuedexta® (dextromethorphan/quinidine) effective January 1, 2022, with a revision dated March 25, 2026. The policy requires prior authorization for this medication used to treat Pseudobulbar Affect (PBA) and mandates that providers attest that QT prolongation risks have been considered and treatment benefits outweigh risks. This is a pharmacy coverage policy affecting Medicare Advantage members only.
Action Required
By April 1, 2026: Billing and pharmacy teams must ensure all Nuedexta® requests include prior authorization processing through Humana Medicare Advantage. Update internal workflows to: (1) Require providers to document diagnosis of PBA caused by qualifying neurologic condition (stroke, MS, ALS, Parkinson's, TBI); (2) Verify member is experiencing characteristic PBA episodes (inappropriate laughing/crying); (3) Confirm member age is 18+; (4) Obtain provider attestation that QT prolongation risk has been evaluated and benefits outweigh risks. Before processing any claims, verify the most current policy version at www.humana.com/PAL. Claims submitted without complete prior authorization and required attestations will be denied. Flag any member with contraindications (prolonged QT interval, heart failure, congenital long QT syndrome, concurrent MAO inhibitor use, complete AV block without pacemaker) and route to medical director review.