Medicare AdvantagePrior AuthLow impact
Bylvay® (odevixibat) (Revised)
Humana·Gastroenterology, Pediatrics·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
This is a new prior authorization policy for Bylvay® (odevixibat), a medication for treating pruritus in patients with Progressive Familial Intrahepatic Cholestasis (PFIC) and Alagille Syndrome (ALGS). The policy establishes specific criteria including genetic confirmation, age requirements, specialist prescribing, and previous treatment failures that must be met for Medicare Advantage coverage approval.
Action Required
By January 1, 2026: Billing team must implement prior authorization requirements for Bylvay® (odevixibat) prescriptions for Medicare Advantage patients. Ensure providers document genetic confirmation of PFIC or ALGS, age requirements (3+ months for PFIC, 12+ months for ALGS), specialist consultation, previous treatment failures with ursodiol/rifampin/cholestyramine, and absence of portal hypertension. Prior authorization requests will be denied without complete documentation of all criteria.