Medicare AdvantagePrior AuthMedium impact
Xiidra® (lifitegrast ophthalmic solution) (Revised)
Humana·Ophthalmology, Optometry·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jul 2, 2026
Summary
Humana Medicare Advantage has implemented a prior authorization requirement for Xiidra (lifitegrast ophthalmic solution) for dry eye disease treatment. Effective January 1, 2025, claims require documented prior treatment failure/intolerance to cyclosporine eye drops AND one of three alternative agents (Eysuvis, Miebo, or Tryptyr) before Xiidra approval. All Xiidra prescriptions for MA members now require prior auth submission.
Action Required
By January 1, 2025: Billing and clinical teams must implement prior authorization verification for all Xiidra prescriptions for Medicare Advantage members. (1) Update billing software to flag Xiidra claims as requiring prior auth before submission. (2) Instruct providers and clinical staff to document in patient charts: diagnosis of dry eye disease AND evidence of previous treatment/contraindication/intolerance to cyclosporine (Restasis) AND use of at least one alternative agent (Eysuvis, Miebo, or Tryptyr). (3) Front desk/authorization staff must obtain prior auth through Humana's PAL system (www.humana.com/PAL) before dispensing. (4) Update intake forms and clinical documentation templates to capture required treatment history. Failure to obtain prior authorization will result in claim denials for Medicare Advantage beneficiaries.