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

  • LMWH – Low-molecular-weight heparin
  • Lutathera (lutetium Lu 177 dotatate)
  • Sinuva (mometasone furoate) sinus implant
  • Symdeko (tezacaftor-ivacaftor)

New medical coverage policies

  • No new policies

Revised pharmacy coverage policies

  • No revised policies

Revised medical coverage policies

  • Bone density measurement
  • Brachytherapy
  • Code compendium
  • Electrical stimulators for pain and nausea/vomiting
  • Erectile dysfunction and Peyronie’s disease treatments
  • Glaucoma — emerging treatments
  • Intra-operative neurological monitoring
  • Molecular diagnostic assays for transplant rejection, breath testing for transplant rejection
  • Molecular diagnostic testing for reproductive health
  • Orthotics
  • Pharmacogenomics (pharmacogenetics) — noncancer indications