Medicare AdvantagePrior AuthMedium impact
Livalo® (pitavastatin) (Revised)
Humana·Cardiology, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2022
We identified it
Jun 25, 2026
Summary
Humana has revised its Livalo® (pitavastatin) pharmacy coverage policy effective January 1, 2022, with the most recent revision dated February 25, 2026. This is a Step Therapy policy requiring members to have documented previous treatment, intolerance, or contraindication to BOTH Zypitamag and ezetimibe before Livalo coverage is approved. Billing teams must ensure prior authorization is obtained with evidence of failed or contraindicated prior therapies before processing claims.
Action Required
Immediately: Billing team must implement step therapy verification for all Livalo® (pitavastatin) claims submitted to Humana Medicare Advantage plans. Before processing any claim, obtain prior authorization documentation confirming the member has received prior treatment, demonstrated intolerance, or has documented contraindications to BOTH Zypitamag and ezetimibe. Update billing software and prior authorization templates to require this dual-therapy documentation. Front desk staff should flag any Livalo prescriptions in the authorization queue and route them to the clinical authorization specialist for step therapy verification. Claims submitted without evidence of failed prior therapies will be denied. Refer to www.humana.com/PAL for current preauthorization and notification requirements.