Medicare AdvantagePrior AuthMedium impact
Fibrate Products (Revised)
Humana·Cardiology, Endocrinology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2017
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its Fibrate Products step therapy policy (effective 1/1/2017, revised 11/26/2025). The policy implements a step therapy requirement for fenofibrate micronized capsules, requiring members to have prior treatment with both a generic fenofibrate micronized capsule (67mg, 134mg, or 200mg) AND a generic fenofibrate tablet (48mg, 54mg, 145mg, or 160mg) before approval. This is a FRESH 1-DAY-OLD revision requiring immediate attention.
Action Required
IMMEDIATE ACTION REQUIRED - By December 6, 2025: (1) Billing and prior authorization teams must update all pharmacy authorization protocols to enforce the dual prior treatment requirement for fenofibrate micronized capsules. (2) Configure pharmacy billing system to deny initial requests for fenofibrate micronized capsules unless documentation shows prior treatment with BOTH a micronized capsule strength (67mg, 134mg, or 200mg) AND a tablet strength (48mg, 54mg, 145mg, or 160mg). (3) Notify all providers and pharmacies dispensing to Humana Medicare Advantage members of the step therapy requirement. (4) Update clinical decision support tools and prior authorization forms to reflect the dual-medication history requirement. (5) Train prior authorization staff on the new dual-criteria approval logic. Without implementation, claims for fenofibrate micronized capsules lacking complete treatment history will be denied and require rework.