Medicare AdvantagePrior AuthMedium impact
Recorlev® (levoketoconazole) Tablet (Revised)
Humana·Endocrinology, Internal Medicine, Pharmacy·Medicare Advantage
Effective date
Jan 22, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Recorlev® (levoketoconazole) effective January 22, 2025. The policy requires prior authorization for this orphan drug used to treat Cushing's syndrome, with three mandatory approval criteria: confirmed Cushing's syndrome diagnosis, patient ineligibility for or failure of surgical intervention, and documented prior treatment failure or contraindication/intolerance to oral ketoconazole. Billing teams must ensure all Recorlev claims include prior authorization and supporting clinical documentation before submission to avoid denials.
Action Required
By January 22, 2025: Billing team must implement the following changes: (1) Update billing system to flag all Recorlev (levoketoconazole) tablet claims as requiring prior authorization before claim submission; (2) Create a pre-submission checklist requiring providers to document: (a) diagnosis of Cushing's syndrome, (b) reason patient is not a surgical candidate or why surgery was not curative, (c) prior treatment history with oral ketoconazole including specific contraindication or intolerance rationale and why this is not expected to apply to levoketoconazole therapy; (3) Distribute this checklist to all prescribing providers and clinical staff; (4) Configure billing system to attach required documentation to prior auth requests automatically; (5) Train front desk and billing staff to identify Recorlev prescriptions and initiate prior auth workflow immediately upon receipt. Do NOT bill claims without completed prior authorization. Claims submitted without prior authorization or incomplete documentation will be denied by Humana Medicare Advantage. Update internal policies and EMR templates to reflect this requirement.