Medicare AdvantagePrior AuthLow impact
Juxtapid® (lomitapide) (New)
Humana·Cardiology, Endocrinology, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage is implementing a new prior authorization policy for Juxtapid (lomitapide) capsules effective January 1, 2026. This medication requires strict criteria including genetic confirmation or high LDL levels for homozygous familial hypercholesterolemia, prior Repatha treatment/contraindication, and mandatory low-fat diet documentation.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for Juxtapid (lomitapide) capsules for Humana Medicare Advantage members. Ensure providers document genetic testing results or LDL-C levels >400 mg/dL, previous Repatha treatment history, and low-fat diet initiation with vitamin supplementation before prescribing. Visit www.humana.com/PAL for specific preauthorization codes and procedures.