Medicare AdvantagePrior AuthMedium impact
Lerochol™ (lerodalcibep-liga) (New)
Humana·Cardiology, Endocrinology, Family Medicine +2 more·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Lerochol (lerodalcibep-liga), a PCSK9 inhibitor for hypercholesterolemia, requires Medicare Advantage members to be 18+, have failed/contraindicated statins, and previously tried Repatha before approval. This is a brand new drug coverage policy effective April 22, 2026.
Action Required
By April 22, 2026: Billing and clinical teams must implement prior authorization requirements for Lerochol (lerodalcibep-liga) prescriptions for Medicare Advantage patients. Ensure documentation includes: diagnosis of hypercholesterolemia, patient age 18+, evidence of statin failure/intolerance or use as adjunctive therapy with high-intensity statin, and previous trial/contraindication to Repatha. Update EMR templates to capture required criteria. Claims will be denied without prior authorization approval.