MedicaidPrior AuthMedium impact
Cytotec® (misoprostol) (Revised)
Humana·SC · Gastroenterology, OB-GYN, Family Medicine +1 more·Medicaid
Effective date
May 16, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established prior authorization requirements for Cytotec (misoprostol) effective May 16, 2025. The policy covers two indications: NSAID-induced gastric ulcer prevention for high-risk patients, and medication-induced pregnancy termination under specific legal conditions per South Carolina's Fetal Heartbeat and Protection from Abortion Act.
Action Required
By May 16, 2025: Billing team must ensure prior authorization is obtained before prescribing Cytotec (misoprostol) for South Carolina Medicaid patients. Providers must document either high-risk criteria for NSAID-induced gastric ulcer prevention or specific legal requirements for pregnancy termination per South Carolina law. Update pharmacy prior auth processes and inform providers that claims will be denied without proper authorization.