Medicare AdvantagePrior AuthMedium impact
Bynfezia Pen™ (octreotide acetate) injection (Revised)
Humana·Endocrinology, Oncology, Gastroenterology +2 more·Medicare Advantage
Effective date
Feb 28, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated the prior authorization policy for Bynfezia Pen (octreotide acetate) injection effective February 28, 2024. The policy maintains prior authorization requirements across six indications (acromegaly, metastatic carcinoid tumors, VIPomas, chemotherapy/radiation-induced diarrhea, AIDS-related severe secretory diarrhea, and carcinoid crisis hypotension), with a key requirement that members must have had previous treatment or intolerance with generic subcutaneous octreotide before coverage. No fundamental changes to approval criteria were identified in this revision.
Action Required
By February 28, 2024: Billing and prior authorization teams must verify that the system reflects the most current Humana Medicare Advantage prior authorization requirements for Bynfezia Pen (J2353). Ensure that all claim submissions for octreotide acetate injection include documentation of: (1) specific diagnosis matching one of the six covered indications, (2) failure of or contraindication to generic subcutaneous octreotide, and (3) for specific indications, required pre-therapy trials (e.g., loperamide for Grade 1-2 chemotherapy diarrhea; antimicrobial/anti-motility agents for AIDS diarrhea). Update prior authorization request templates to require this documentation. Providers should be notified to include evidence of prior octreotide treatment or documented intolerance on all Bynfezia requests. Claims submitted without prior authorization or missing required clinical documentation will be denied by Humana Medicare Advantage plans.