Medicare AdvantagePrior AuthMedium impact
Pancreatic Enzymes (Revised)
Humana·Gastroenterology, Internal Medicine, Pediatrics +1 more·Medicare Advantage
Effective date
Jan 1, 2016
We identified it
Jun 25, 2026
Summary
Humana updated its Pancreatic Enzymes pharmacy coverage policy (Pancreaze, Pertzye, Viokace) effective January 1, 2016, with the most recent revision on August 27, 2025. This is a step therapy policy requiring members to have prior treatment with or intolerance to Creon AND Zenpep before coverage of the listed pancreatic enzyme products is approved. The policy applies to Medicare Advantage members with exocrine pancreatic insufficiency.
Action Required
By September 15, 2025: Billing and prior authorization teams must verify that all pharmacy claims for Pancreaze (delayed-release capsule), Pertzye (delayed-release capsule), and Viokace (tablet) include documentation of prior treatment with or intolerance to BOTH Creon AND Zenpep before submission. Update pharmacy billing system and prior authorization workflow to require this step therapy verification. When processing claims for Medicare Advantage members, flag any Pancreatic Enzyme requests lacking evidence of prior Creon and Zenpep failure/intolerance and request documentation from the prescribing provider before claim approval. Failure to implement this step therapy requirement will result in claim denials for non-compliant submissions. Communicate this requirement to all providers who prescribe these medications.