Medicare AdvantagePrior AuthMedium impact
Omvoh (mirikizumab) (Revised)
Humana·Gastroenterology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established new prior authorization requirements for Omvoh (mirikizumab), a medication used to treat moderate to severe ulcerative colitis and Crohn's disease in adults. The policy requires patients to have failed specific prior therapies before approval, with different step therapy requirements for IV versus subcutaneous formulations.
Action Required
By January 1, 2025: Billing and clinical teams must implement prior authorization workflow for all Omvoh (mirikizumab) prescriptions for Humana Medicare Advantage patients. Verify patient age (18+), diagnosis of moderate-severe ulcerative colitis or Crohn's disease, and document required prior therapy failures before prescribing. For IV formulation: must have failed infliximab AND ustekinumab/Tremfya. For subcutaneous: must have failed TWO of the specified medications (adalimumab, ustekinumab, Skyrizi, Rinvoq, or Tremfya). Claims will be denied without proper prior authorization.