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

  • Erleada (apalutmiade)
  • Noctiva (desmopressin)
  • Proton pump inhibitors
  • Rhopressa (netarsudil)
  • Soliqua
  • Trintellix (vortioxetine)
  • Trogarzo (ibalizumab-uiyk)
  • Xultophy

New medical coverage policies

  • Janus Kinase 2 (JAK2) V617F, Exon 12 – 15, Calreticulin (CALR) and MPL mutation analysis

Revised pharmacy coverage policies

  • No revised policies

Revised medical coverage policies

  • Achalasia and gastroesophageal reflux disease (GERD) treatments
  • Breast reconstruction
  • Genetic testing for diagnosis and monitoring – noncancer indications
  • Infertility evaluation and treatments
  • Rhinoplasty/Septoplasty
  • Sleep studies, adult
  • Spinal cord stimulators
  • Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT)