Medicare AdvantagePrior AuthHigh impact
Prandial and Intermediate Acting Insulins (New)
Humana·Endocrinology, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a new step therapy policy for prandial and intermediate acting insulins, requiring members to try specific preferred insulins (Fiasp, Novolog, Novolin products, or generic equivalents) before accessing Humalog, Admelog, Apidra, Lyumjev, and other listed insulin products. Members with prior treatment history with preferred insulins receive automatic approval.
Action Required
Before January 1, 2026: Billing team must update prior authorization workflows to verify patient history with preferred insulins (Fiasp, Novolog, Novolin products, or generics) before prescribing step therapy insulins. Providers must document previous insulin treatment history in medical records. Update EMR templates to capture required step therapy criteria. Claims for covered insulins without proper documentation or step therapy compliance may be denied.