Medicare AdvantagePrior AuthMedium impact
Rezdiffra™ (resmetirom)
Humana·Gastroenterology, Internal Medicine, Family Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage will require prior authorization for Rezdiffra (resmetirom), a new medication for metabolic dysfunction-associated steatohepatitis (MASH/NASH), starting January 1, 2026. Coverage requires meeting 6 specific criteria including confirmed diagnosis, moderate to advanced liver fibrosis, and prescription by a specialist.
Action Required
Before January 1, 2026: Billing team must update prior authorization systems to require approval for Rezdiffra (resmetirom) for Humana Medicare Advantage members. Providers treating MASH/NASH patients must obtain prior auth by confirming all 6 criteria: noncirrhotic MASH diagnosis with liver biopsy/VCTE/MRE, age 18+, F2-F3 fibrosis stage, combination with diet/exercise, specialist prescription, and metabolic risk factors. Visit www.humana.com/PAL for medical coding information.