Medicare AdvantagePrior AuthLow impact
Redemplo® (plozasiran) (New)
Humana·Endocrinology, Cardiology, Gastroenterology·Medicare Advantage
Effective date
Feb 25, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Redemplo (plozasiran), a specialty injection for treating familial chylomicronemia syndrome. Prior authorization is required with specific clinical criteria including fasting triglycerides ≥880 mg/dL, genetic confirmation or clinical scoring, low-fat diet compliance, and specialist involvement.
Action Required
By February 25, 2026: Billing team must update prior authorization requirements for Redemplo (plozasiran) injections for Humana Medicare Advantage patients. Ensure providers document fasting triglyceride levels ≥880 mg/dL, FCS diagnosis criteria, low-fat diet compliance, and specialist consultation before prescribing. Visit www.humana.com/PAL for specific medical coding information and preauthorization requirements.