Medicare AdvantagePrior AuthMedium impact
Growth Hormone (Revised)
Humana·Endocrinology, Pediatrics, Internal Medicine·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
Humana revised its Growth Hormone therapy coverage policy (effective July 22, 2026) for Medicare Advantage members, establishing detailed prior authorization requirements for 17 GH products across pediatric and adult indications. The policy specifies strict diagnostic criteria including growth failure measurements, GH stimulation test results, and specific syndrome diagnoses. Omnitrope is designated as the preferred product for both adults and children.
Action Required
By July 22, 2026: Billing team must implement prior authorization requirements for all growth hormone claims under Medicare Advantage. (1) Update billing system to flag ALL growth hormone products (Skytrofa, Genotropin MiniQuick, Genotropin, Nutropin AQ Nuspin, Nutropin AQ, Humatrope, Saizen, Zomacton, HumatroPen, Norditropin FlexPro, Omnitrope, Sogroya, Ngenla) as requiring prior auth before claim submission. (2) Providers must document specific clinical criteria in prior auth requests: for pediatric cases—bone age delay, growth velocity measurements (specific thresholds by age), GH stimulation test results (<10 ng/ml), or diagnosis of GH deficiency syndromes (SGA, SHOX, renal insufficiency, Prader-Willi, Turner's, Noonan); for adult cases—documented GHD diagnosis with TWO GH stimulation tests (one must be ITT) or documented exceptions. (3) Ensure providers understand that Omnitrope is preferred; requests for other products may require justification. (4) Front desk staff must verify Medicare Advantage plan type at time of scheduling. Failure to obtain prior authorization will result in claim denials. Reference the full policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867e2.