Medicare AdvantagePrior AuthMedium impact
GLP-1 Analogs (Revised)
Humana·Endocrinology, Internal Medicine, Family Medicine +1 more·Medicare Advantage
Effective date
Mar 27, 2024
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage revised its GLP-1 Analog step therapy policy on March 27, 2024. The policy requires members to have failed or been intolerant to at least two of six specified GLP-1 analogs (Victoza, Trulicity, Ozempic, Bydureon, Rybelsus, or Mounjaro) before coverage of Byetta or generic exenatide is approved. This step therapy requirement remains in effect and applies to both Byetta subcutaneous pen injectors and exenatide subcutaneous pen injectors.
Action Required
By April 15, 2024: Billing and prior authorization teams must implement step therapy verification for all Byetta and exenatide pen injector requests on Humana Medicare Advantage plans. Before processing claims or prior authorization requests, verify that members have documented treatment history or documented intolerance to at least TWO of the following agents: Victoza (liraglutide), Trulicity (dulaglutide), Ozempic (semaglutide), Bydureon (exenatide extended-release), Rybelsus (semaglutide), or Mounjaro (tirzepatide). Update prior authorization software to trigger automatic rejection or manual review for requests that cannot demonstrate step therapy completion. Train front-line staff and providers to gather treatment history during intake. Claims submitted without documented step therapy evidence will be denied. Refer providers to http://apps.humana.com/tad/tad_new/home.aspx to verify current policy version before submission.