Medicare AdvantagePrior AuthMedium impact
Xultophy® (insulin degludec and liraglutide) (Revised)
Humana·Endocrinology, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Xultophy® (insulin degludec and liraglutide) effective January 1, 2025, with a revision date of April 22, 2026. The policy requires prior authorization for all Xultophy prescriptions and establishes five clinical approval criteria, including a new requirement that patients must have previous treatment with Soliqua before Xultophy can be approved. Billing teams must verify all five criteria are met before processing claims to avoid denials.
Action Required
Before January 1, 2025: Billing and clinical staff must implement prior authorization processes for all Xultophy 100/3.6 prescriptions. Create a checklist in the billing system to verify the five approval criteria: (1) Type 2 diabetes mellitus diagnosis, (2) adjunctive use with diet/exercise, (3) no concurrent liraglutide or other GLP-1 agonists, (4) no concurrent prandial insulin, and (5) prior Soliqua treatment documented. Update provider order entry forms and prior auth submission templates to require documentation of previous Soliqua therapy. Route all Xultophy requests to medical review before claim submission. Educate prescribers that claims will be denied if any criterion is not met, particularly the Soliqua prerequisite, which represents a change from standard GLP-1 sequencing. Establish workflow to track approval duration (plan year or clinical review determination) for renewal submissions.