New and Revised Pharmacy and Medical Coverage Policies Available

Coverage policies

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 by reviewing "How to Read a Medical Coverage Policy" and "Understanding the Medical Coverage Policy Development Process" under “Helpful Links.”

Below are new, revised and retired policies:

New pharmacy coverage policies

  • Byvalson (nebivolol and valsartan)
  • Cabometyx (cabozanitib)
  • Epclusa (sofosbuvir/velpatasvir)
  • GLP-1 Analogs
  • Ocaliva (obeticholic acid)
  • Otovel (ciprofloxacin-fluocinolone otic solution)
  • Pediatric Antipsychotic Utilization Program
  • Probuphine (buprenorphine) Implant
  • Tecentriq (atezolizumab)
  • Xiidra (lifitegrast ophthalmic solution)
  • Zinbryta (daclizumab)
  • Zurampic (lesinurad)

Revised pharmacy coverage policies

  • No revised pharmacy coverage policies

New medical coverage policies

  • No new medical coverage policies

Revised medical coverage policies

  • Acupuncture
  • Benign prostatic hyperplasia (BPH) treatments
  • Benign skin lesion removal
  • Clinical trials
  • Cosmetic surgery, reconstructive surgery, scar revision
  • Deep brain stimulation (DBS) and cortical brain stimulation
  • Drug testing
  • Electrical stimulators for pain and nausea/vomiting
  • Erectile dysfunction treatments
  • Fecal microbiota transplantation (FMT)
  • Gastrointestinal (GI) motility monitoring
  • Genetic testing for breast and/or ovarian cancer susceptibility
  • Genetic testing for cystic fibrosis
  • Injections for chronic pain conditions
  • Keratoconus – surgical treatments
  • Mobility assistive devices (wheelchairs)
  • Obstructive sleep apnea (OSA) surgical treatments
  • Osteochondral defects surgery
  • Pharmacogenomics and companion diagnostics
  • Sleep studies, adult
  • Tissue Doppler imaging (tissue Doppler echocardiography, tissue Doppler ultrasound)
  • Ultraviolet light/laser therapy for skin conditions
  • Videofluoroscopy, dynamic MRI for musculoskeletal indications

Retired medical coverage policies

  • No retired medical coverage policies