Medicare AdvantagePrior AuthHigh impact
Angiotensin Blocking Agents (Revised)
Humana·Cardiology, Internal Medicine, Nephrology +3 more·Medicare Advantage
Effective date
Jan 1, 2023
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Angiotensin Blocking Agents pharmacy coverage policy (effective 1/1/2023, revised 7/23/2025) to implement step therapy requiring members to have prior treatment with at least two ACE inhibitors or ARBs before coverage approval for newer agents (Edarbi, Edarbyclor, Arbli, azilsartan, valsartan oral solution). This is a step therapy requirement that affects prior authorization processes for these medications.
Action Required
By August 6, 2025 (immediately): Billing and prior authorization teams must implement the following for all Humana Medicare Advantage claims: (1) Verify member has documented prior treatment history with at least TWO of the following agents before authorizing Edarbi, Edarbyclor, Arbli, azilsartan, or valsartan oral solution: lisinopril, lisinopril-HCTZ, ramipril, benazepril, benazepril-HCTZ, quinapril, quinapril-HCTZ, enalapril, enalapril-HCTZ, losartan, losartan-HCTZ, valsartan, valsartan-HCTZ, irbesartan, irbesartan-HCTZ, olmesartan, or olmesartan-HCTZ. (2) Update prior authorization templates and pharmacy billing system to enforce this step therapy requirement. (3) Train clinical staff to request prior treatment documentation from patient records or providers before submitting authorization requests. (4) Flag any claims for these five medications lacking evidence of two prior antihypertensive treatments—these will be denied without proper step therapy completion. (5) Contact Humana's PAL (Preauthorization and Notification List) portal at www.humana.com/PAL for updated claim coding requirements. Failure to verify step therapy criteria will result in claim denials.