Medicare AdvantagePrior AuthMedium impact
Corticotropin Products (Revised)
Humana·OH · Neurology, Rheumatology, Nephrology +2 more·Medicaid
Effective date
Apr 24, 2024
We identified it
Jun 24, 2026
Summary
Humana updated their prior authorization policy for corticotropin products (Acthar Gel, Cortrophin Gel) effective April 24, 2024, applying to Medicare, Commercial, and Ohio Medicaid plans. The policy establishes specific criteria for approval including contraindication to other treatments and step therapy requirements for conditions like West syndrome, multiple sclerosis exacerbations, and other steroid-responsive conditions.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all corticotropin products (Acthar Gel, Cortrophin Gel) before administration. Providers must document contraindication to cosyntropin for diagnostic testing, West syndrome diagnosis for infantile spasms, or failed corticosteroid therapy with contraindications for other conditions. Update encounter forms to include prior auth reminders for these specialty medications. Claims will be denied without proper prior authorization.