Medicare AdvantagePrior AuthMedium impact
Myqorzo™ (aficamten) (New)
Humana·Cardiology, Internal Medicine, Family Medicine·Medicare Advantage
Effective date
Mar 25, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing prior authorization requirements for Myqorzo (aficamten), a new medication for obstructive hypertrophic cardiomyopathy. The policy requires strict clinical criteria including confirmed diagnosis, failed previous treatments, and specific heart function parameters, with initial 6-month approvals and ongoing monitoring requirements.
Action Required
By March 25, 2026: Billing team must update prior authorization workflows for Myqorzo (aficamten) prescriptions for Humana Medicare Advantage patients. Providers must document hypertrophic cardiomyopathy diagnosis, obstruction confirmation via cardiac imaging, NYHA Class II-III symptoms, LVEF >55%, and previous treatment failures with beta-blockers or calcium channel blockers. Ensure prescribers are enrolled in the Myqorzo REMS program before prescribing. Claims will require prior authorization approval before dispensing.