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 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)