Medicare AdvantagePrior AuthMedium impact
MODD1 Insulin Delivery System (New)
Humana·Endocrinology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for the MODD1 Insulin Delivery System, an FDA-cleared insulin pump for diabetes patients. This requires prior auth approval before prescribing the device to Medicare Advantage members, with specific clinical criteria including age 18+, inadequate glycemic control despite multiple daily injections, and ability to perform frequent glucose monitoring.
Action Required
By March 25, 2026: Billing team must implement prior authorization requirements for MODD1 Insulin Delivery System (Patient Welcome Kit and Supply Kit combo pack) for all Humana Medicare Advantage members. Update billing software to flag these requests and ensure providers complete prior auth documentation including diabetes diagnosis, age verification, glycemic control history, and glucose monitoring capability. Visit www.humana.com/PAL for specific procedural coding information. Claims submitted without prior authorization will be denied.