Medicare AdvantagePrior AuthMedium impact
Furoscix® (furosemide) (Revised)
Humana·Cardiology, Nephrology, Internal Medicine +1 more·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Aug 12, 2026
Summary
Humana updated its Furoscix (furosemide) prior authorization policy for Medicare Advantage plans, effective December 28, 2022, with a revision dated December 17, 2025. The policy requires prior authorization for subcutaneous Furoscix injections in patients with heart failure or chronic kidney disease who have edema and prior loop diuretic treatment. Billing teams must ensure all Furoscix claims include proper prior authorization before submission to avoid denials.
Action Required
By December 17, 2025: Billing and clinical teams must implement prior authorization requirements for all Furoscix (furosemide) subcutaneous wearable injector kits and ReadyFlow auto-injectors submitted to Humana Medicare Advantage plans. Before submission, verify patients meet ALL three criteria: (1) diagnosis of heart failure OR chronic kidney disease/nephrotic syndrome, (2) documented edema, and (3) prior treatment with oral loop diuretic. Update claim submission workflows to route Furoscix claims through prior authorization process via Humana's PAL system (www.humana.com/PAL). Train billing and prior auth staff on the three-part approval criteria. Update encounter forms and EMR templates to prompt providers to document loop diuretic history. Failure to obtain prior authorization will result in claim denials.