Medicare AdvantagePrior AuthMedium impact
Regranex® (becaplermin) (Revised)
Humana·Endocrinology, General Practice, Internal Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2021
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Regranex® (becaplermin) topical gel, effective January 1, 2021, with the most recent revision dated May 27, 2026. The policy requires prior authorization for becaplermin use in treating lower extremity diabetic neuropathic ulcers, with mandatory criteria including adequate blood supply, subcutaneous tissue involvement, and concurrent standard ulcer care practices. Exclusion applies for patients with known neoplasms at the application site.
Action Required
Immediately: Billing team must implement prior authorization requirement for all Regranex® (becaplermin) topical gel claims under Humana Medicare Advantage plans. Before submitting claims: (1) Verify member meets all four coverage criteria (lower extremity diabetic ulcer treatment, ulcer extends to subcutaneous tissue or beyond, adequate blood supply, use with standard ulcer care); (2) Confirm no exclusions exist (no known neoplasm at application site); (3) Submit prior authorization request through Humana's PAL system at www.humana.com/PAL before dispensing medication. Update billing system to flag all becaplermin claims for prior auth verification. Failure to obtain prior authorization will result in claim denials. Note: Policy revision date of May 27, 2026 is very recent—verify this is the current version before processing claims.