Medicare AdvantagePrior AuthMedium impact
Xdemvy® (lotilaner) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Xdemvy® (lotilaner) ophthalmic solution, effective January 1, 2026 and revised May 27, 2026. The medication requires prior authorization with a single clinical criterion: confirmed diagnosis of Demodex blepharitis. Billing teams must implement prior authorization workflows for this newly covered pharmaceutical.
Action Required
By December 15, 2025: Billing team and prior authorization staff must implement prior authorization requirements for Xdemvy® (lotilaner) ophthalmic solution 0.25% in the billing system and PA portal. Update pharmacy billing workflows to require PA submission prior to claim submission. Train clinical staff that the sole approval criterion is documented diagnosis of Demodex blepharitis. Communicate with ophthalmology and optometry providers in-network about the new PA requirement. Document all PA requests with ICD-10 code for Demodex blepharitis. Failure to obtain prior authorization will result in claim denials for Humana Medicare Advantage members.