Medicare AdvantagePrior AuthMedium impact
Zepbound® (tirzepatide) (Revised)
Humana·Endocrinology, Bariatric Surgery, Internal Medicine·Medicare Advantage
We identified it
Jul 23, 2026
Summary
This is a revised prior authorization policy for Zepbound® (tirzepatide) affecting Medicare Advantage members. The policy update requires verification of coverage criteria and prior authorization procedures before dispensing this medication. Billing teams must ensure all claims comply with the updated authorization requirements.
Action Required
Immediately: Obtain and review the complete revised Zepbound® (tirzepatide) prior authorization policy from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5867d4). Billing team must: (1) Update pharmacy billing system to reflect any changes in prior authorization requirements for tirzepatide claims, (2) Notify prescribers and pharmacy staff of the policy revision, (3) Implement any new documentation or eligibility verification requirements before processing claims. Claims submitted without compliance to the revised prior authorization requirements will be denied. Contact Humana directly to confirm effective date and specific coverage criteria changes, as this summary-only source does not provide implementation details.