Medicare AdvantagePrior AuthMedium impact
Tyvaso® (treprostinil) (Revised)
Humana·SC, VA · Pulmonology, Cardiology·Medicaid
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization criteria for Tyvaso (treprostinil) for treating pulmonary arterial hypertension and pulmonary hypertension with interstitial lung disease. The policy now requires specific diagnostic confirmation and prior therapy attempts with other medications before approval.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Tyvaso (treprostinil) prescriptions for Humana Medicare and Medicaid members in South Carolina and Virginia. Providers must document right heart catheterization confirmation of diagnosis and prior therapy attempts with endothelin receptor antagonists or phosphodiesterase type 5 inhibitors. Claims without proper prior authorization will be denied.