CommercialPrior AuthMedium impact
Fibrate Products (Revised)
Humana·Cardiology, Internal Medicine, Endocrinology +2 more·Commercial
Effective date
Jan 1, 2020
We identified it
Jun 25, 2026
Summary
This is a revised Humana Commercial pharmacy step therapy policy for fibrate products (fenofibrate and fenofibric acid derivatives) that was updated on January 24, 2024. The policy requires members to have prior treatment with generic fenofibrate micronized capsule (67mg, 134mg, or 200mg) OR generic fenofibrate tablet (48mg, 54mg, 145mg, or 160mg) before coverage of brand or alternative fibrate formulations is approved. The approval duration is for the initial plan year.
Action Required
By January 31, 2024: Pharmacy billing team and prior authorization staff must update internal systems and workflows to enforce step therapy requirement for all fibrate product claims on Humana Commercial plans. Specifically: (1) Configure billing system to require documentation of prior generic fenofibrate treatment before approving claims for Fenoglide, Lipofen, Trilipix, fenofibric acid tablets, or fenofibric acid capsules; (2) Update prior authorization submission templates to request proof of prior generic fenofibrate use (fill history or member records); (3) Train pharmacy team to deny or request additional documentation for any fibrate claim that cannot demonstrate prior generic fenofibrate therapy; (4) Communicate this requirement to prescribing providers in practice. Claims submitted without evidence of prior generic fenofibrate treatment will be denied or placed on hold pending documentation review.