Medicare AdvantagePrior AuthLow impact
Livdelzi® capsule (Revised)
Humana·Gastroenterology, Internal Medicine·Medicare Advantage
Effective date
Nov 27, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Livdelzi® (seladelpar) capsules used to treat primary biliary cholangitis. The policy establishes specific criteria including diagnosis documentation, specialist prescribing requirements, and evidence of ursodiol intolerance or inadequate response.
Action Required
Immediately: For patients prescribed Livdelzi® capsules, billing team must ensure prior authorization is obtained before dispensing. Providers must document all five criteria: PBC diagnosis with two supporting tests, no complete biliary obstruction, no decompensated cirrhosis history, prescription by gastroenterologist/hepatologist, and ursodiol intolerance or inadequate response. Update prior auth request forms to include these specific requirements.