Medicare AdvantagePrior AuthLow impact
Lotronex (alosetron) (Revised)
Humana·Gastroenterology, Family Medicine, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has established new prior authorization requirements for Lotronex (alosetron) for Medicare Advantage members with severe diarrhea-predominant irritable bowel syndrome. The policy requires documentation of chronic symptoms lasting 6+ months and failure of at least two specific alternative treatments before approval.
Action Required
By January 1, 2025: Billing team must update prior authorization workflow for Lotronex (alosetron) prescriptions for Humana Medicare Advantage members. Ensure providers document severe IBS-D diagnosis, chronic symptoms lasting 6+ months, and failure/contraindication to at least two of: loperamide, tricyclic antidepressants (amitriptyline, nortriptyline, imipramine, desipramine), or Xifaxan (rifaximin). Claims without proper prior authorization will be denied.