Medicare AdvantagePrior AuthMedium impact
Livmarli® (maralixibat) (Revised)
Humana·Gastroenterology, Pediatrics, Pharmacy·Medicare Advantage
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage updated its Livmarli® (maralixibat) prior authorization policy on December 17, 2025, clarifying coverage criteria for cholestatic pruritus in Alagille Syndrome (ALGS) and Progressive Familial Intrahepatic Cholestasis (PFIC). The revision reinforces strict prior authorization requirements including specialist prescription, failed prior treatment, and specific diagnostic criteria (confirmed diagnosis with clinically significant pruritus and elevated serum bile acids). A critical new exclusion prohibits coverage for PFIC Type 2 patients with non-functional ABCB11 variants.
Action Required
By December 24, 2025: Billing team and providers must implement the following: (1) When processing Livmarli claims for Medicare Advantage members, verify prior authorization is obtained before claim submission - all claims require initial prior auth approval valid for plan year duration; (2) Update prior authorization request templates to require documentation of: confirmed diagnosis (ALGS or genetically confirmed PFIC), clinically significant cholestasis-associated pruritus as determined by prescriber, lab evidence of elevated serum bile acids above upper limit of normal, and prescriber specialty (hepatologist, gastroenterologist, or equivalent); (3) For ALGS claims, verify member has prior treatment history or contraindication to at least one of: ursodiol, rifampin, or cholestyramine; (4) For PFIC claims, apply the new exclusion - deny coverage if member has PFIC Type 2 with ABCB11 variants resulting in non-functional or complete absence of BSEP protein; (5) Verify absence of portal hypertension or hepatic decompensation history for all approvals (contraindication for both indications); (6) Update denial letters to cite specific unmet criteria when prior auth is denied. Failure to implement these requirements will result in claim rejections and potential patient financial liability. Reference the full policy at www.humana.com/PAL for current prior authorization and notification lists.