MedicaidPrior AuthMedium impact
Leqvio® (inclisiran) (Revised)
Humana·OH · Cardiology, Internal Medicine, Family Medicine·Medicaid
We identified it
Jul 1, 2026
Summary
Humana has revised its Prior Authorization policy for Leqvio® (inclisiran) affecting Medicaid members in Ohio. This is a medication policy update for a PCSK9 inhibitor used to treat high cholesterol. The billing team must obtain prior authorization before claims submission to avoid denials.
Action Required
Immediately: Billing team must implement prior authorization requirement for Leqvio® (inclisiran) claims for all Ohio Medicaid members. Update billing system workflows to flag Leqvio® prescriptions for prior auth submission before claim submission. Notify providers to obtain authorization before dispensing. Contact Humana at the source URL or customer service to obtain the full policy details including specific coverage criteria, medical necessity requirements, and PA submission procedures. Claims submitted without prior authorization will be denied. Access the complete policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a614 to confirm all requirements before implementation.