Medicare AdvantagePrior AuthMedium impact
Non-Preferred Testosterone Products (Revised)
Humana·Endocrinology, Urology, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for non-preferred testosterone products effective January 1, 2025. The policy requires members to have documented hypogonadism, low testosterone lab values, and previous treatment with generic testosterone 1.62% gel plus either testosterone cypionate or enanthate injections before approving brand-name or non-preferred testosterone formulations.
Action Required
By January 1, 2025: Billing and clinical staff must verify prior authorization requirements before prescribing or billing for non-preferred testosterone products (Vogelxo, Jatenzo, Aveed, Xyosted, Tlando, Kyzatrex, Androderm, AndroGel, Fortesta, Testim) for Humana Medicare Advantage members. Providers must document: 1) Primary or secondary hypogonadism diagnosis, 2) Two separate morning serum testosterone levels below reference range, and 3) Previous treatment with generic testosterone 1.62% gel AND testosterone cypionate or enanthate injections. Update EMR templates to capture required documentation. Claims without prior authorization will be denied.