Medicare AdvantagePrior AuthMedium impact
Lybalvi (olanzapine and samidorphan) (New)
Humana·Psychiatry, Family Medicine, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Lybalvi (olanzapine and samidorphan), a new psychiatric medication for schizophrenia and bipolar I disorder. Patients must have tried generic alternatives first and cannot be using opioids concurrently.
Action Required
By January 1, 2025: Billing team must update prior authorization workflow for Lybalvi prescriptions. Providers must document diagnosis of schizophrenia or bipolar I disorder, prior therapy attempts with generic alternatives (olanzapine, risperidone, quetiapine, ziprasidone, aripiprazole, or lurasidone), and confirm patient is not using opioids. Submit prior auth requests through Humana's system before prescribing. Claims will be denied without prior authorization approval.