Medicare AdvantagePrior AuthMedium impact
Yorvipath® (palopegteriparatide) (Revised)
Humana·Endocrinology, Internal Medicine·Medicare Advantage
Effective date
Dec 18, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has issued a new prior authorization policy for Yorvipath (palopegteriparatide) effective December 18, 2024, for treating chronic hypoparathyroidism in adults. Prior authorization is now required, and coverage is limited to patients meeting specific clinical criteria including failed conventional therapy, normal vitamin D levels, adequate serum calcium, and endocrinologist prescription. Acute post-surgical hypoparathyroidism is excluded from coverage.
Action Required
By December 18, 2024: Billing team must implement prior authorization requirement for all Yorvipath (palopegteriparatide) prescriptions for Humana Medicare Advantage members. Configure billing system to flag Yorvipath claims and route to prior authorization workflow before submission. Providers must verify patient meets all four clinical criteria (chronic hypoparathyroidism diagnosis, inadequate control on conventional therapy, normal vitamin D and serum calcium ≥7.8 mg/dL, and endocrinologist prescription) before requesting authorization. Ensure front desk and clinical staff document these criteria in patient records to support PA requests. Claims submitted without prior authorization or for acute post-surgical hypoparathyroidism will be denied. Update patient financial counseling materials to reflect new authorization requirement.