Medicare AdvantagePrior AuthMedium impact
Leqvio® (inclisiran) (Revised)
Humana·SC · Cardiology, Endocrinology, Internal Medicine +1 more·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Leqvio (inclisiran) injections for Medicare and Medicaid patients in South Carolina. The policy requires patients to meet specific age criteria, diagnosis requirements, and have tried or been intolerant to high-intensity statins before approval.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Leqvio (inclisiran) subcutaneous injections for Humana Medicare and Medicaid patients in South Carolina. Verify patients meet age requirements (18+ for hypercholesterolemia, 12+ for familial hypercholesterolemia), have appropriate diagnosis codes, and document statin therapy attempts or contraindications. For Medicare Advantage PDP plans, step therapy with Repatha is required unless continuation of prior therapy within 365 days.