Medicare AdvantagePrior AuthLow impact
Somavert® (pegvisomant) (Revised)
Humana·Endocrinology·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for Somavert (pegvisomant) effective January 1, 2026. The policy requires members to meet specific criteria including acromegaly diagnosis, inadequate response to surgery/radiation, and previous treatment with dopamine agonist or somatostatin analogue.
Action Required
Before January 1, 2026: Billing and prior authorization teams must establish workflow to obtain prior authorization for Somavert (pegvisomant) prescriptions for Medicare Advantage members. Verify patients meet all three criteria: acromegaly diagnosis, inadequate response to surgery/radiation therapy, and previous treatment/contraindication/intolerance to dopamine agonist or somatostatin analogue. Visit www.humana.com/PAL for specific medical coding information.