Medicare AdvantagePrior AuthMedium impact
Myalept® (metreleptin) (Revised)
Humana·Endocrinology, Internal Medicine, Genetics·Medicare Advantage
Effective date
Jan 1, 2017
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicare Advantage prior authorization policy for Myalept (metreleptin) effective January 1, 2017, with the most recent revision dated September 24, 2025. The policy requires prior authorization for Myalept coverage in patients with congenital or acquired generalized lipodystrophy, with specific exclusions for partial lipodystrophy, liver disease (including NASH), HIV-related lipodystrophy, and generalized obesity. Billing teams must ensure all Myalept claims undergo prior authorization review and verify member eligibility against the five defined exclusion criteria before claim submission.
Action Required
REQUIREMENTS:
- Immediately: Billing team must verify current policy version in Humana's online system at www.humana.com/PAL before processing any Myalept (metreleptin) claims, as printed versions become uncontrolled.
- Before claim submission: Confirm that all Myalept prescriptions have obtained prior authorization from Humana; claims submitted without prior auth will be denied.
- For each Myalept claim: Verify member meets inclusion criterion (diagnosis of congenital OR acquired generalized lipodystrophy) AND does NOT have any of the five exclusions (partial lipodystrophy, liver disease/NASH, HIV-related lipodystrophy, diabetes/hypertriglyceridemia without concurrent lipodystrophy, or generalized obesity not associated with congenital leptin deficiency).
- Update billing software to flag all Myalept claims as requiring prior authorization for Medicare Advantage members.
- Educate providers that prescribers must be certified with the Myalept REMS Program and pharmacies must be certified; ensure referral to Humana PAL for required claim codes and authorization procedures.
- Review REMS Program requirements: notify providers that Myalept is available only through the restricted REMS program due to risks of anti-metreleptin antibodies and lymphoma.