Medicare AdvantagePrior AuthMedium impact
Zypitamag® (pitavastatin) (Revised)
Humana·Cardiology, Internal Medicine, Endocrinology +3 more·Medicare Advantage
Effective date
May 1, 2021
We identified it
Jun 25, 2026
Summary
Humana has revised its Zypitamag® (pitavastatin) pharmacy coverage policy effective May 1, 2021, with the most recent revision dated October 22, 2025. This is a step therapy policy for Medicare Advantage members with hyperlipidemia that provides automatic approval for patients with prior treatment on simvastatin, pravastatin, lovastatin, atorvastatin, or rosuvastatin. The policy includes important safety warnings regarding myopathy, rhabdomyolysis, immune-mediated necrotizing myopathy, and hepatic dysfunction that billing teams should communicate to providers.
Action Required
By November 5, 2025: Pharmacy and prior authorization teams must ensure that Zypitamag (pitavastatin) requests are processed under step therapy protocol. Verify member history for prior statin use (simvastatin, pravastatin, lovastatin, atorvastatin, or rosuvastatin) before authorization. Update prior auth system to automatically approve requests for members with documented prior statin therapy. Ensure prior auth staff are aware of the serious safety warnings (myopathy, rhabdomyolysis, INMM, hepatic dysfunction) and communicate these to prescribing providers. For Medicare Advantage members without prior statin therapy documented, process as step therapy requiring clinical review. Communicate this policy change to in-network providers and update internal PA procedures. Failure to follow step therapy requirements may result in claim denials.