Medicare AdvantagePrior AuthMedium impact
Lodoco® (colchicine) (Revised)
Humana·Cardiology, Internal Medicine·Medicare Advantage
Effective date
Dec 20, 2023
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Prior Authorization policy for Lodoco® (colchicine) effective December 20, 2023, with the most recent revision dated November 26, 2025. This is a pharmacy coverage policy requiring prior authorization for colchicine use in Medicare Advantage members with atherosclerotic cardiovascular disease (ASCVD) who meet specific clinical criteria including maximally tolerated statin therapy and optimization on standard cardiovascular medications.
Action Required
By December 20, 2023 (retroactive to current date): Billing and prior authorization teams must implement Lodoco® (colchicine) prior authorization requirement for all Humana Medicare Advantage members. (1) Update billing system to flag any Lodoco® prescriptions for Medicare Advantage members as requiring prior authorization before claim submission. (2) Create or update prior authorization request template to require documentation of: (a) ASCVD diagnosis or prior cardiovascular event, (b) current statin therapy at maximally tolerated dose OR statin intolerance with alternative lipid-lowering therapy, and (c) concurrent standard ASCVD medications (aspirin, antiplatelets, anticoagulants, ACE-I/ARB, beta-blockers). (3) Notify providers and pharmacy staff that Lodoco® requires prior authorization and cannot be dispensed without approval. (4) Train authorization staff on the three approval criteria. (5) Set authorization duration for initial and renewal plan years per policy. Failure to obtain prior authorization before claim submission will result in claim denials for Humana Medicare Advantage members.