New and Revised Pharmacy and Medical Coverage Policies Available

Humana’s medical and pharmacy coverage policies are based on evidence published in peer-reviewed medical literature, technology assessments obtained from independent medical research organizations, evidence-based consensus statements and evidence-based guidelines from nationally recognized professional healthcare organizations.

Information about medical and pharmacy coverage policies can be found at Humana.com/provider by selecting “Medical and Pharmacy Coverage Policies” under “Resources.” Policies can be reviewed by name or revision date. Users also may search for a particular policy using the search box. More detailed information can be found under “Helpful Links” by reviewing “How to Read a Medical and Pharmacy Coverage Policy” and “Understanding the Medical and Pharmacy Coverage Policy Development Process.”

Recent changes to medical and pharmacy coverage policies are listed below:

New pharmacy coverage policies

  • Braftovi (encorafenib)
  • Jynarque (tolvaptan)
  • Kapspargo sprinkle capsule (metoprolol succinate)
  • Mektovi (binimetinib)
  • Olumiant (baricitinib)
  • Palynziq (pegvaliase-pqpz)
  • Yonsa (abiraterone acetate)

New medical coverage policies

  • Complementary and alternative medicine

Revised pharmacy coverage policies

  • Antidepressant agents
  • Cinryze (C1 esterase inhibitor, human)
  • Ruconest (C1 esterase inhibitor, recombinant)
  • Xeljanz and Xeljanz XR (tofacitinib)
  • Pomalyst (pomalidomide)

Revised medical coverage policies

  • Comparative genomic hybridization/chromosomal microarray analysis
  • Cosmetic surgery, reconstructive surgery, scar revision
  • Deep brain stimulation (DBS) and cortical brain stimulation
  • Fecal microbiota transplantation
  • Fusion imaging
  • Gastric pacing
  • Genetic testing for cardiac conditions
  • Genetic testing for cystic fibrosis
  • Genetic testing for disease risk
  • Injections for chronic pain conditions
  • Obstructive sleep apnea (OSA) and other sleep-related breathing disorders, nonsurgical treatments
  • Obstructive sleep apnea (OSA) surgical treatments
  • Percutaneous vertebroplasty, kyphoplasty (balloon-assisted vertebroplasty), sacroplasty
  • Proton and neutron beam radiation therapy
  • Reduction mammaplasty
  • Ultraviolet light/laser therapy for skin conditions
  • Ventricular assist device (VAD), total artificial heart (TAH)