Medicare AdvantagePrior AuthMedium impact
Iqirvo® (elafibranor) (Revised)
Humana·Gastroenterology, Internal Medicine·Medicare Advantage
Effective date
Sep 25, 2024
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Iqirvo (elafibranor), a medication used to treat primary biliary cholangitis. This policy requires specific clinical criteria to be met, including documented diagnosis, no complete biliary obstruction, no history of decompensated cirrhosis, specialist prescription, and either ursodiol intolerance or inadequate response to ursodiol therapy.
Action Required
Immediately: Billing and clinical teams must implement prior authorization requirements for Iqirvo (elafibranor) prescriptions for Humana Medicare Advantage patients. Ensure providers document all five criteria including PBC diagnosis with two supporting elements, absence of biliary obstruction and decompensated cirrhosis, specialist involvement, and ursodiol intolerance or inadequate response. Update EMR templates to capture required documentation. Claims will be denied without proper prior authorization.