Medicare AdvantagePrior AuthMedium impact
Xiidra® (lifitegrast ophthalmic solution) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
We identified it
Jul 2, 2026
Summary
This is a revised Prior Authorization policy for Xiidra® (lifitegrast ophthalmic solution) for Medicare Advantage members. The billing team must verify authorization requirements before dispensing or billing this medication, as claims submitted without prior authorization will be denied.
Action Required
Immediately: Billing and clinical staff must obtain prior authorization from Humana Medicare Advantage before dispensing or billing Xiidra® (lifitegrast ophthalmic solution). Access the policy at https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56a5b0 to review specific authorization criteria. Update pharmacy and billing system workflows to flag Xiidra prescriptions for prior auth verification. Communicate to prescribing providers that this medication requires pre-approval. Claims submitted without documented prior authorization will be denied and require rework.