Traditional MedicarePrior AuthLow impact
Evkeeza™ (evinacumab-dgnb) (Revised)
Humana·KY, SC · Cardiology, Endocrinology, Internal Medicine·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated the prior authorization policy for Evkeeza (evinacumab-dgnb) for treating Homozygous Familial Hypercholesterolemia, with specific criteria for diagnosis and LDL-C levels. The policy applies to Medicare and Medicaid plans in Kentucky and South Carolina, with different step therapy requirements based on plan type.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for Evkeeza (evinacumab-dgnb) claims for Medicare and Medicaid patients in Kentucky and South Carolina. Verify patients meet all three criteria including HoFH diagnosis, current LDL-C >70mg/dL despite maximally tolerated lipid therapy, and previous treatment with/contraindication to Repatha (except for Medicaid requests). Update billing system to flag these requirements.