Medicare AdvantagePrior AuthMedium impact
Fensolvi® (leuprolide acetate) subcutaneous syringe (Revised)
Humana·Pediatrics, Endocrinology·Medicare Advantage
Effective date
Dec 18, 2024
We identified it
Jun 25, 2026
Summary
This is a revision to Humana's Fensolvi (leuprolide acetate) prior authorization policy for Medicare Advantage plans, updated December 18, 2024. The policy confirms that Fensolvi requires prior authorization for pediatric patients 2+ years old with central precocious puberty, with approval granted for plan year durations for both initial and renewal requests. Billing teams must ensure all Fensolvi claims are submitted with prior authorization before processing.
Action Required
By December 18, 2024: Billing team must verify that all Fensolvi (leuprolide acetate) subcutaneous syringe claims for Medicare Advantage members include prior authorization documentation before submission. Update billing system to flag Fensolvi claims requiring prior authorization. Ensure claims are submitted only after prior auth approval is obtained from Humana. Train billing staff that Fensolvi approvals are granted for plan year durations (both initial and renewal). Claims submitted without prior authorization will be denied. For medically billed requests, staff should reference www.humana.com/PAL for specific procedure coding information.