MedicaidPrior AuthMedium impact
Triptodur™ (triptorelin) (New)
Humana·OH · Pediatrics, Endocrinology, Pharmacy·Medicaid
Effective date
Aug 1, 2026
We identified it
Aug 7, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Triptodur (triptorelin) effective August 1, 2026, for treating central precocious puberty in pediatric patients 2 years and older. This is a pharmacy-level prior authorization requiring single criterion verification: confirmed diagnosis of central precocious puberty. All claims for this medication now require pre-approval before dispensing.
Action Required
By August 1, 2026: Billing team and pharmacy staff must implement prior authorization requirements for Triptodur (triptorelin) for all Ohio Medicaid members. Specifically: (1) Update pharmacy billing system to flag all Triptodur claims as requiring prior authorization; (2) Create workflow requiring verification of central precocious puberty diagnosis before claim submission; (3) Notify all prescribing providers (typically pediatric endocrinologists) that prior authorization must be obtained before medication dispensing; (4) Establish communication protocol with Humana's PAL (Preauthorization and Notification List) system per www.humana.com/PAL for submission of medically billed requests. Pharmacy staff should monitor response with LH levels 1-2 months after initiation, measure height every 3-6 months, and periodically monitor bone age as documented in the policy. Failure to obtain prior authorization will result in claim denials for Ohio Medicaid members.