Medicare AdvantagePrior AuthMedium impact
Dojolvi™ (triheptanoin) Oral Liquid (Revised)
Humana·Pediatrics, Genetics, Internal Medicine·Medicare Advantage
Effective date
Jan 28, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Dojolvi™ (triheptanoin) Oral Liquid prior authorization policy effective January 28, 2026. The policy requires prior authorization for coverage, with two mandatory approval criteria: (1) confirmed diagnosis of long-chain fatty acid oxidation disorders (VLCAD, CPT2, TFP, or LCHAD deficiency), and (2) genetic/molecular testing confirmation. Initial and renewal approvals are granted for plan year durations.
Action Required
By January 28, 2026: Billing and prior authorization teams must implement prior authorization requirements for all Dojolvi (triheptanoin) oral liquid claims submitted to Humana Medicare Advantage plans. Before claim submission, verify that patient records document: (1) ICD-10 diagnosis code for specific LC-FAOD type (VLCAD, CPT2, TFP, or LCHAD deficiency), and (2) evidence of genetic/molecular testing results confirming pathogenic mutations in CPT2, ACADVL, HADHA, or HADHB genes. Update billing software workflow to flag Dojolvi claims for mandatory prior auth review. Train providers and front desk staff that claims submitted without prior authorization will be denied. Coordinate with prescribing providers to obtain supporting genetic testing documentation before submitting authorization requests.