Medicare AdvantagePrior AuthMedium impact
Rayos® (prednisone delayed-release) (Revised)
Humana·Allergy & Immunology, Dermatology, Gastroenterology +10 more·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Aug 19, 2026
Summary
Humana Medicare Advantage updated its Rayos (prednisone delayed-release) prior authorization policy effective January 1, 2022, with a revision dated February 25, 2026. The policy requires two-part criteria: (1) use for specific anti-inflammatory/immunosuppressive conditions, and (2) prior treatment with both prednisone immediate-release AND at least one other generic corticosteroid. All Rayos prescriptions now require prior authorization with approval granted in plan-year durations.
Action Required
By March 15, 2026: Billing and clinical teams must implement prior authorization requirements for all Rayos (prednisone delayed-release) claims submitted to Humana Medicare Advantage plans. Before submitting claims: (1) Verify member has documented prior treatment history with prednisone immediate-release, (2) Confirm treatment with at least one additional generic corticosteroid (dexamethasone, methylprednisolone, prednisolone, or equivalent), (3) Submit prior authorization request through Humana's PAL system at www.humana.com/PAL before dispensing. Update pharmacy dispensing protocols and prior auth tracking systems to flag Rayos prescriptions as requiring dual-corticosteroid history documentation. Failure to obtain prior authorization will result in claim denials for Humana Medicare Advantage members.