MedicaidPrior AuthMedium impact
Leqvio® (inclisiran) (New)
Humana·OH · Cardiology, Endocrinology, Family Medicine +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Leqvio (inclisiran) injections for treating primary hyperlipidemia, requiring patients to be 18+ years old and either on maximally tolerated high-intensity statins or have documented statin intolerance. This is a brand new coverage policy that will require prior authorization for all Leqvio prescriptions.
Action Required
Before January 1, 2026: Billing team must update prior authorization requirements for Leqvio (inclisiran) injections for Ohio Medicaid patients. Providers must document patient age 18+, primary hyperlipidemia diagnosis, and either maximally tolerated high-intensity statin use with failed LDL-C goals OR statin-associated muscle symptoms with documentation of statin intolerance. Visit www.humana.com/PAL for specific medical billing codes and prior authorization forms.