Medicare AdvantagePrior AuthMedium impact
Bowel Prep Agents (Revised)
Humana·Gastroenterology, General Surgery, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has implemented a new step therapy policy for bowel prep agents effective January 1, 2025. Members must try or be unable to use Suflave, Sutab, or generic Suprep before coverage will be approved for brand-name bowel prep agents like Clenpiq, MoviPrep, Golytely, Plenvu, and Suprep Bowel Prep Kit.
Action Required
Immediately: Billing team must update prior authorization procedures for bowel prep agents. Before prescribing Clenpiq, MoviPrep, Golytely, Plenvu, or Suprep Bowel Prep Kit for Humana Medicare Advantage members, providers must document that patient has tried or cannot use Suflave, Sutab, or generic Suprep. Update EMR templates and prior authorization forms to capture this step therapy requirement. Claims may be denied without proper documentation of failed first-line therapy.