Medicare AdvantagePrior AuthMedium impact
Amitiza® (lubiprostone) (Revised)
Humana·Gastroenterology, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2024
We identified it
Jun 24, 2026
Summary
Humana has revised their prior authorization policy for Amitiza (lubiprostone) for Medicare Advantage plans, requiring step therapy with specific medications before approval for IBS-C, chronic constipation, and opioid-induced constipation. The policy requires previous treatment or contraindication to Linzess for IBS-C and CIC, and Movantik for opioid-induced constipation.
Action Required
Immediately: Billing team must ensure prior authorization is obtained for all Amitiza (lubiprostone) prescriptions for Medicare Advantage patients. Providers must document previous treatment with, intolerance to, or contraindication to required step therapy medications (Linzess for IBS-C/CIC, Movantik for opioid-induced constipation) before prescribing Amitiza. Update prior auth checklist to include step therapy requirements.