Medicare AdvantagePrior AuthLow impact
Pediatric Adrenocortical Insufficiency Products (Revised)
Humana·Pediatrics, Endocrinology, Pharmacy·Medicare Advantage
Effective date
Sep 24, 2025
We identified it
Jun 25, 2026
Summary
Humana has updated its Medicare Advantage prior authorization policy for pediatric adrenocortical insufficiency treatment products (Alkindi Sprinkle and Khindivi oral solution). The revised policy, effective September 24, 2025, requires prior authorization for these medications when members have a confirmed diagnosis of pediatric adrenocortical insufficiency AND a documented contraindication to hydrocortisone tablets. This is a pharmacy coverage policy requiring two-criteria approval.
Action Required
By September 24, 2025: Billing team and pharmacy staff must implement prior authorization requirements for Alkindi Sprinkle (hydrocortisone 0.5 mg, 1 mg, 2 mg, 5 mg capsules) and Khindivi oral solution (1 mg/1 mL) for Medicare Advantage members. Update pharmacy billing system to flag prescriptions requiring prior auth verification. Verify that both required criteria are documented in member record before claim submission: (1) diagnosis of pediatric adrenocortical insufficiency and (2) documented contraindication to hydrocortisone tablets. Claims submitted without prior authorization approval will be subject to denial. Refer to www.humana.com/PAL for specific preauthorization and notification requirements.