Medicare AdvantagePrior AuthMedium impact
Ursodiol Products (Revised)
Humana·Gastroenterology, General Surgery, Internal Medicine +1 more·Medicare Advantage
Effective date
Aug 26, 2026
We identified it
Aug 27, 2026
Summary
This revised Humana Medicare Advantage policy updates prior authorization requirements for ursodiol products (Reltone, Ursolign capsules). Coverage for gallstone treatment and prevention now requires documented prior treatment or intolerance with generic ursodiol tablets or 300 mg capsules. The policy clarifies that these brand/specific-dose capsule formulations require prior auth and reinforces the 24-month safety limitation.
Action Required
By September 26, 2026: Billing team must implement prior authorization workflow for all Reltone (ursodiol 200mg/400mg capsules) and Ursolign (ursodiol 150mg capsules) prescriptions for Humana Medicare Advantage members. (1) Update billing system to flag these specific formulations for prior auth requirement before claim submission. (2) Ensure prior auth requests include documentation that patient has prior treatment or intolerance with generic ursodiol tablets or 300 mg capsules. (3) Do NOT require prior auth for generic ursodiol tablets, 250mg tablets, 300mg capsules, or URSO Forte 500mg tablets—those are excluded from this policy. (4) Notify providers that claims for Reltone or Ursolign submitted without prior authorization will be denied by Humana. (5) Flag any approvals exceeding 24 months of continuous therapy as potential coverage limits for medical director review. Update encounter documentation templates to capture prior medication trial history.