MedicaidPrior AuthMedium impact
Gattex® (teduglutide) (Revised)
Humana·KY, SC · Gastroenterology, General Surgery·Medicaid
We identified it
Jul 22, 2026
Summary
This is a revised Prior Authorization policy for Gattex® (teduglutide) affecting Medicare and Medicaid members in Kentucky and South Carolina. The policy update requires billing teams to verify current authorization requirements for this specialty pharmaceutical before processing claims.
Action Required
Immediately: Billing team must access the complete policy details at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867ec to determine specific prior authorization requirements for Gattex® (teduglutide) HCPCS code J1562. Update billing software rules and provider alerts to reflect any new or revised prior auth requirements for Kentucky and South Carolina Medicaid members. Obtain prior authorization before claim submission. Claims submitted without required prior authorization will be denied.