Medicare AdvantagePrior AuthLow impact
Tryngolza ™ (olezarsen) (Revised)
Humana·Endocrinology, Cardiology·Medicare Advantage
Effective date
Feb 26, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Tryngolza (olezarsen), a new medication for familial chylomicronemia syndrome, effective February 26, 2025. Patients must meet strict criteria including fasting triglycerides ≥880 mg/dL, genetic confirmation or clinical scoring for FCS, and specialist consultation.
Action Required
By February 26, 2025: Billing team must update prior authorization protocols for Tryngolza (olezarsen) subcutaneous auto-injector for Medicare Advantage patients. Ensure providers document all four criteria: fasting triglycerides ≥880 mg/dL, FCS diagnosis confirmation, low-fat diet compliance, and specialist consultation. Visit www.humana.com/PAL for specific preauthorization codes. Claims will be denied without proper prior authorization.