MedicaidPrior AuthMedium impact
Corticotropin Products (Revised)
Humana·KY, SC · Neurology, Rheumatology, Pulmonology +4 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for corticotropin products (Acthar Gel, Cortrophin Gel) effective January 1, 2025. The policy establishes specific criteria for coverage across four conditions: West Syndrome, MS exacerbations, rheumatic/collagen diseases, and symptomatic sarcoidosis, with most requiring failed corticosteroid therapy first.
Action Required
Immediately: Update prior authorization protocols for corticotropin products (Acthar Gel, Cortrophin Gel). Billing team must ensure providers document failed corticosteroid therapy, specialist consultation, and specific diagnostic criteria before prescribing. Create documentation checklists for West Syndrome (age <2), MS exacerbations (current DMT use), rheumatic conditions, and sarcoidosis cases. Claims will be denied without proper prior authorization and documentation.