Medicare AdvantagePrior AuthMedium impact
Tymlos® (abaloparatide) subcutaneous injection (Revised)
Humana·Endocrinology, Rheumatology, Orthopedics +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage updated prior authorization requirements for Tymlos (abaloparatide) osteoporosis injections, effective January 1, 2026. The policy requires strict criteria including osteoporosis diagnosis, high fracture risk factors, and limits cumulative lifetime use to 2 years when combined with parathyroid hormone analogs.
Action Required
By January 1, 2026: Billing team must update prior authorization requirements for Tymlos (abaloparatide) in billing system for Medicare Advantage patients. Ensure providers document osteoporosis diagnosis, high/very high fracture risk criteria, and previous therapy failures or intolerances. Track cumulative lifetime use limits of 2 years. Claims will be denied without proper prior authorization.