Medicare AdvantagePrior AuthMedium impact
Pancreatic Enzymes (Revised)
Humana·Gastroenterology, Internal Medicine, Pediatrics·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 22, 2026
Summary
This is a revised Humana Medicare Advantage pharmacy policy for pancreatic enzymes (Pancreaze, Pertzye, Viokace) effective immediately as of the revision date July 22, 2026. The policy implements a step therapy requirement: members must have previous treatment with or documented intolerance to both Creon AND Zenpep before approval for the covered pancreatic enzyme products. This is a step therapy policy requiring prior authorization before dispensing.
Action Required
By July 22, 2026: Billing and pharmacy teams must implement step therapy verification in pharmacy processing systems for all pancreatic enzyme claims (Pancreaze capsules, Pertzye capsules, Viokace tablets) under Humana Medicare Advantage plans. Before dispensing these medications, verify member has documented previous treatment or intolerance to BOTH Creon AND Zenpep. If step therapy criteria are not met, deny claim and communicate requirement to provider/member. Update pharmacy system rules and staff training on this two-drug step therapy requirement. Failure to enforce step therapy will result in claim denials on appeal.