Medicare AdvantagePrior AuthMedium impact
Increlex® (mecasermin injection) (Revised)
Humana·Pediatrics, Endocrinology·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Increlex® (mecasermin injection) prior authorization policy effective January 28, 2026. The policy maintains coverage criteria for severe primary IGF-1 deficiency and GH gene deletion with neutralizing antibodies in pediatric patients, with approval granted for plan year durations. Key requirement: treatment must discontinue when epiphyses close, and initial therapy requires documentation of specific diagnostic criteria including height/IGF-1 standard deviation scores and normal/elevated growth hormone levels.
Action Required
By January 28, 2026: Billing and prior authorization staff must update internal documentation and system workflows to reflect the revised Increlex policy. Specifically: (1) Ensure all prior authorization requests for Increlex include verification of the three diagnostic criteria (Height SDS ≤ -3.0, Basal IGF-1 SDS ≤ -3.0, and normal/elevated GH), (2) Confirm patients do not meet the discontinuation criterion (closed epiphyses), (3) Verify thyroid and nutritional deficiencies are corrected before initiation, (4) Document that height velocity increases by at least 2 cm/year during first year or flag for compliance/etiology reassessment, (5) Confirm no history of malignancy/current malignant neoplasia, (6) Set approval duration to plan year for both initial and renewal authorizations. Providers must be notified of updated documentation requirements. Claims submitted without proper prior authorization or complete documentation will be denied.