Medicare AdvantagePrior AuthHigh impact
Xiidra® (lifitegrast ophthalmic solution) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Xiidra (lifitegrast ophthalmic solution) pharmacy coverage policy effective January 1, 2025, with an update dated June 25, 2025. The policy requires prior authorization for Xiidra and mandates that patients must have documented previous treatment, contraindication, or intolerance to BOTH cyclosporine eye drops (generic Restasis) AND Eysuvis (loteprednol) before approval. Approvals are granted for the plan year duration or as determined through clinical review.
Action Required
By January 1, 2025 (or immediately if already past this date): Billing team must implement prior authorization requirements for all Xiidra (lifitegrast ophthalmic solution) claims in the billing system. Front desk and clinical staff must verify that patient charts document BOTH: (1) previous treatment with or contraindication/intolerance to cyclosporine eye drops (generic Restasis), AND (2) previous treatment with or contraindication/intolerance to Eysuvis (loteprednol) before submitting PA requests. Update all encounter forms and EMR templates to include a documentation checklist for these two required prior treatments. Route all Xiidra prescriptions to the authorization department—do not process claims without documented evidence of failed or contraindicated prior therapies. Claims submitted without proof of both prior treatment requirements will be denied by Humana Medicare Advantage plans.