Medicare AdvantagePrior AuthMedium impact
Harvoni (ledipasvir/sofosbuvir) (Revised)
Humana·Gastroenterology, Infectious Disease, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their prior authorization policy for Harvoni (hepatitis C treatment), now requiring patients to have failed or have contraindications to Epclusa before Harvoni can be approved. This adds a new step-therapy requirement that wasn't previously specified.
Action Required
By January 1, 2026: Prior to prescribing Harvoni for hepatitis C patients on Humana Medicare Advantage plans, providers must document that the patient has either failed to achieve SVR (sustained virologic response) after completing a full course of Epclusa OR has a contraindication to Epclusa. Update prior authorization submission templates to include this step-therapy documentation requirement. Claims will be denied without proper Epclusa failure/contraindication documentation.