Medicare AdvantagePrior AuthMedium impact
Orgovyx (relugolix) (Revised)
Humana·Oncology, Urology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for Orgovyx (relugolix), an oral medication used for advanced prostate cancer treatment. The policy requires members to have advanced prostate cancer or high risk of disease recurrence, with specific exclusions for pediatric patients and concurrent LHRH analog use.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Orgovyx (relugolix) prescriptions for Humana Medicare Advantage members. Verify patients meet criteria (advanced prostate cancer or high recurrence risk) and check exclusions (no concurrent LHRH analogs, age 18+). Claims will be denied without proper prior authorization.