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HumanaMedicare Advantage · Prior Auth · Medicare Advantage · Endocrinology, Internal Medicine, Family Medicine +1 moreHigh impact

DPP-IV, SGLT2 Combination Products (New)

Act
by Dec 15, 2026
Effective date
Jan 1, 2027
Identified
Sep 30, 2026

Summary

Humana Medicare Advantage has implemented a new prior authorization policy for DPP-IV/SGLT2 combination diabetes medications (Steglujan, Qtern, Glyxambi, dapagliflozin-saxagliptin). Effective January 1, 2027, all claims for these products require prior authorization and must meet two criteria: Type 2 Diabetes Mellitus diagnosis AND documented trial or contraindication to a single DPP-4 inhibitor (sitagliptin or linagliptin) OR a single SGLT2 inhibitor (empagliflozin or dapagliflozin). Approvals are granted for plan year durations or as determined through clinical review.

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What to do

by Dec 15, 2026 · 6 steps
01Billing team must implement prior authorization requirements in billing system for all DPP-IV/SGLT2 combination products (Steglujan, Qtern, Glyxambi, dapagliflozin-saxagliptin combination).
02Update encounter forms and templates to require providers to document: (1) Type 2 Diabetes Mellitus diagnosis, and (2) evidence of trial or contraindication to either sitagliptin OR linagliptin (DPP-4 inhibitor) OR empagliflozin OR dapagliflozin (SGLT2 inhibitor).
03Configure system to block claims submission without prior authorization approval.
04Notify prescribing providers and front desk staff of new requirement.
05Train staff on submission process via Humana PAL system.
06Claims submitted without prior authorization will be denied.

Original notice

DPP-IV, SGLT2 Combination Products (New)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
SGLT2 Inhibitors (New)HighEffective Jan 1, 2027 · Medicare AdvantageDPP-IV, SGLT2 Combination Products (Revised)MediumEffective Jan 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list

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