Medicare AdvantagePrior AuthLow impact
Korlym® (mifepristone) (Revised)
Humana·Endocrinology, Internal Medicine·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its Korlym® (mifepristone) pharmacy coverage policy effective December 17, 2025. The policy maintains prior authorization requirements for this medication, which is indicated to control hyperglycemia secondary to hypercortisolism in adult patients with endogenous Cushing's syndrome who have type 2 diabetes or glucose intolerance and have failed surgery or are not surgical candidates. No substantial coverage criteria changes are evident, but the revision date indicates policy clarification or administrative updates have been made.
Action Required
By December 17, 2025: Verify current Korlym® (mifepristone) prior authorization procedures in Humana Medicare Advantage systems align with revised policy requirements. Confirm that all three criteria are checked before claim submission: (1) endogenous Cushing's syndrome diagnosis, (2) type 2 diabetes mellitus or glucose intolerance, and (3) failed surgery or non-surgical candidate status. Billing team should verify that prior auth is requested through Humana's PAL system (www.humana.com/PAL) and that claims submitted without prior authorization will be denied. Review staff should be aware of the black box warning regarding pregnancy termination and contraception requirements, though this primarily affects prescribers. No immediate system changes required unless internal documentation processes need alignment with the revised policy language.