Medicare AdvantagePrior AuthMedium impact
Uceris® Tablet and Rectal Foam (budesonide) (Revised)
Humana·Gastroenterology·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
This is a Medicare Advantage prior authorization policy for Uceris (budesonide) tablet and rectal foam used to treat mild-to-moderate active ulcerative colitis. The policy requires prior authorization and mandates that members must have failed or be intolerant to at least TWO aminosalicylate agents (sulfasalazine, balsalazide, mesalamine enema, or mesalamine ER capsules) before Uceris can be approved. The policy was revised on December 17, 2025, and remains effective from January 1, 2022.
Action Required
Immediately: Billing team must update prior authorization protocols for all Uceris prescriptions (budesonide delayed-release tablet, extended-release tablet, and rectal foam) in the Medicare Advantage population. Before submitting any Uceris claims, verify that patient charts document: (1) active mild-to-moderate ulcerative colitis diagnosis, and (2) prior treatment with or documented intolerance to at least TWO of the following agents: sulfasalazine tablets, balsalazide capsules, mesalamine enema, or mesalamine 0.375g extended-release capsules. Route all Uceris requests through the prior authorization process and approve for initial plan year duration with renewal for subsequent plan years. Communicate requirements to gastroenterology providers to ensure prescriptions include required documentation. Claims submitted without prior authorization or incomplete documentation will be denied.