Medicare AdvantagePrior AuthHigh impact
Preferred GLP-1 Agonists and GLP-1/GIP Agonists (Revised)
Humana·Endocrinology, 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 GLP-1 medications (Ozempic, Mounjaro, Rybelsus, Trulicity) starting January 1, 2025. These medications are only approved for type 2 diabetes treatment and explicitly excluded for weight loss purposes.
Action Required
By January 1, 2025: Billing team must implement prior authorization requirements for all GLP-1 medications (Ozempic, Mounjaro, Rybelsus, Trulicity) for Humana Medicare Advantage patients. Update billing system to flag these medications for prior auth. Providers must document type 2 diabetes diagnosis and confirm medication is NOT for weight loss. Visit www.humana.com/PAL for specific preauthorization requirements. Claims without prior authorization will be denied.