MedicaidPrior AuthMedium impact
Lanreotide Products (Revised)
Humana·KY, SC · Endocrinology, Oncology, Gastroenterology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established prior authorization requirements for lanreotide products (including Somatuline Depot) for Medicaid plans in Kentucky and South Carolina, covering three conditions: acromegaly, gastroenteropancreatic neuroendocrine tumors, and carcinoid syndrome. The policy requires specific diagnostic criteria and may require prior therapy with generic alternatives before approving brand Somatuline Depot.
Action Required
By January 1, 2025: Billing and clinical teams must obtain prior authorization from Humana before prescribing lanreotide or Somatuline Depot for Medicaid patients in Kentucky and South Carolina. Ensure documentation includes appropriate diagnosis (acromegaly, GEP-NETs, or carcinoid syndrome) and meets specific criteria outlined in policy. For brand Somatuline Depot, document prior therapy with or intolerance to generic lanreotide or Sandostatin LAR. Visit www.humana.com/PAL for medical and procedural coding requirements.