Medicare AdvantagePrior AuthMedium impact
Verquvo® (vericiguat) (Revised)
Humana·Cardiology, Internal Medicine, Geriatrics·Medicare Advantage
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana has revised its Verquvo (vericiguat) prior authorization policy for Medicare Advantage members with heart failure. The policy maintains three strict approval criteria: symptomatic chronic heart failure (NYHA Class II-IV), left ventricular ejection fraction ≤45%, and a worsening cardiac event requiring hospitalization or IV diuretics within the past 6 months. This revision (dated April 22, 2026) reinforces the Black Box Warning regarding fetal harm and pregnancy prevention requirements.
Action Required
By April 22, 2026: Billing team must update prior authorization protocols for Verquvo (vericiguat) claims submitted to Humana Medicare Advantage plans. Verify that all authorization requests include documentation of: (1) NYHA Class II-IV diagnosis for symptomatic chronic heart failure, (2) LVEF ≤45% from recent imaging, and (3) evidence of worsening cardiac event (hospitalization or IV diuretic use) within the past 6 months. Providers must ensure prescriptions include Black Box Warning acknowledgment for female patients of reproductive potential. Update internal tracking systems to set approval duration to initial and renewal plan year cycles. Route all Verquvo requests through prior authorization workflow before claim submission; failure to obtain prior authorization will result in claim denial. Reference the full policy at the Humana PAL website (www.humana.com/PAL) for any medically billed requests.