New and Revised Pharmacy and Medical Coverage Policies Available

Female doctor taking vitals from female patient

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 health care 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

  • Aliqopa (copanlisib)
  • Asthma interleukin inhibitors (Cinqair, Nucala, Fasenra)
  • Bowel-prep agents
  • Calquence (acalabrutinib)
  • Cinvanti (aprepitant)
  • Gocovri (amantadine)
  • Granix (tbo-filgrastim)
  • Hemlibra (emicizumab-kxwh)
  • Long-acting muscarinic antagonist/Long-acting beta agonist combination inhalers
  • Luxturna (voretigene neparvovec)
  • Lyrica CR (pregabalin)
  • Mepsevii (vestronidase alfa-vjbk)
  • Naftin gel (naftifine)
  • Nuedexta (dextromethorphan and quinidine)
  • Opioid Utilization Program — morphine equivalent dose (MED) edits
  • Parsabiv (etelcalcetide)
  • Prevymis (letermovir)
  • Qtern (dapagliflozin and saxagliptin)
  • SGLT2 inhibitors
  • Shingrix (zoster vaccine recombinant, adjuvanted)
  • Solosec (secnidazole)
  • Steglujan (ertugliflozin and sitagliptin)
  • Sublocade (buprenorphine extended-release)
  • Symproic (naldemedine)
  • Taclonex (calcipotriene and betamethasone)
  • Tracleer (bosentan) tablet for oral suspension
  • Trelegy (fluticasone furoate, umeclidinium, vilanterol)
  • Verzenio (abemaciclib)
  • Yescarta (axicabtagene ciloleucel)
  • Zilretta (triamcinolone acetonide extended-release)

New medical coverage policies

  • Genetic testing for diagnosis and monitoring of cancer and molecular profiling

Revised pharmacy coverage policies

  • No revised policies

Revised medical coverage policies

  • Acne treatments
  • Allergy Testing
  • Allograft transplantation of the knee
  • Bariatric surgery
  • Bone graft substitutes
  • Cardioverter defibrillators/cardiac resynchronization therapy
  • Cryoablation
  • Durable medical equipment (DME)
  • Genetic testing for celiac disease
  • Headache and occipital neuralgia treatments
  • Hip, knee and shoulder arthroscopic surgeries
  • Home oximetry monitoring
  • Nasal surgical treatments (balloon dilation and endoscopic)
  • Negative pressure wound therapy (NPWT)
  • Noninvasive tests for hepatic fibrosis
  • Pharmacogenomics and companion diagnostics
  • Pneumatic compression pumps
  • Skin and tissue substitutes
  • Tumor markers for diagnosis and monitoring of cancer
  • Varicose vein treatments