Medicare AdvantagePrior AuthMedium impact
Preferred Testosterone Products (Revised)
Humana·Endocrinology, Urology, Family Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for preferred testosterone products (enanthate, cypionate, transdermal gel) effective January 1, 2025. Coverage requires documented diagnosis of hypogonadism, metastatic breast cancer, or delayed puberty in males, plus specific lab work showing low testosterone levels.
Action Required
Immediately: For Humana Medicare Advantage patients needing testosterone products, obtain prior authorization by documenting qualifying diagnosis (primary/secondary hypogonadism, metastatic breast cancer for females, or delayed puberty in males) and required lab results (two morning serum testosterone levels below reference range for new patients, or current levels for existing patients). Update prior auth tracking system to include these requirements. Claims will be denied without proper authorization.