Medicare AdvantagePrior AuthMedium impact
Yutrepia™ (treprostinil) (Revised)
Humana·Pulmonology, Cardiology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has issued a revised prior authorization policy for Yutrepia (treprostinil) effective January 1, 2026, with updates as of May 27, 2026. The policy establishes strict prior authorization requirements for two indications: Pulmonary Arterial Hypertension (PAH) requiring prior therapy/intolerance to two drug classes plus a third agent, and Pulmonary Hypertension associated with Interstitial Lung Disease (PH-ILD) requiring prior Tyvaso DPI therapy. Billing teams must verify all criteria are met and documented before authorization.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization requirements for Yutrepia (treprostinil) claims submitted to Humana Medicare Advantage plans. For PAH patients: Verify right heart catheterization confirming WHO Group I diagnosis; confirm prior therapy/intolerance/contraindication to BOTH an endothelin receptor antagonist AND a phosphodiesterase type 5 inhibitor or Adempas; confirm prior therapy/intolerance/contraindication to Tyvaso DPI or Uptravi; and verify concurrent use of one of the required combination therapies. For PH-ILD patients: Verify right heart catheterization with pulmonary hypertension AND HRCT/lung biopsy confirming interstitial lung disease (WHO Group 3); confirm prior therapy/intolerance/contraindication to Tyvaso DPI. Update prior authorization submission templates to include these specific documentation requirements. Claims lacking required documentation will be denied. Flag all Yutrepia requests for manual review by billing team to ensure all criteria are satisfied before submission.