Medicare AdvantagePrior AuthMedium impact
Evenity® (romosozumab-aqqg) (Revised)
Humana·SC · Endocrinology, Geriatrics, Rheumatology·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Evenity® (romosozumab-aqqg) affecting Medicaid and Medicare members in South Carolina. The billing team must implement updated prior authorization requirements for this osteoporosis treatment; however, specific clinical criteria, effective date, and billing codes are not detailed in the summary-only content provided.
Action Required
Immediately: Billing team must access the full policy document at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867be to extract specific prior authorization requirements, affected HCPCS codes (likely J1145 or similar biologics codes), and clinical criteria. Update prior authorization submission procedures in billing software and provider portal. Brief providers on new/revised requirements for Evenity® prescriptions. Do not submit claims without confirming current prior auth requirements with Humana South Carolina, as claims lacking required authorization will be denied.