Medicare AdvantagePrior AuthMedium impact
Inpefa™ (sotagliflozin) (Revised)
Humana·Cardiology, Endocrinology, Nephrology +2 more·Medicare Advantage
Effective date
Aug 23, 2023
We identified it
Jun 25, 2026
Summary
Humana has updated its Inpefa (sotagliflozin) pharmacy coverage policy for Medicare Advantage members, effective August 23, 2023 with a revision date of April 22, 2026. This is a Prior Authorization policy requiring members to meet specific clinical criteria: diagnosis of heart failure OR type 2 diabetes with chronic kidney disease and cardiovascular risk factors, PLUS prior treatment/intolerance/contraindication to Jardiance or Farxiga. Billing teams must ensure prior authorization is obtained before dispensing Inpefa tablets to avoid claim denials.
Action Required
By April 22, 2026 (revision date): Billing and pharmacy teams must implement the following: (1) Configure pharmacy billing system to require Prior Authorization for all Inpefa (sotagliflozin) 200mg and 400mg tablet claims for Medicare Advantage members; (2) Establish clinical criteria verification checklist: confirm member has documented heart failure diagnosis OR all three conditions (type 2 diabetes, chronic kidney disease, and cardiovascular risk factors); (3) Verify documentation of prior treatment, intolerance, or contraindication to both Jardiance (empagliflozin) and Farxiga (dapagliflozin) before submitting authorization request; (4) Update pharmacy and provider communications to clarify both medications must be documented as tried/failed/contraindicated; (5) Coordinate with prescribers to obtain required clinical documentation. Claims submitted without prior authorization or missing clinical criteria documentation will be denied. Pharmacy team should flag prescriptions that lack evidence of Jardiance and Farxiga failure history for provider follow-up before authorization submission.