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

Janumet XR (sitagliptin and metformin hydrochloride extended-release) (New)

Act
by Dec 15, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026

Summary

Humana Medicare Advantage has implemented a new prior authorization requirement for Janumet XR (sitagliptin/metformin extended-release) effective January 1, 2027. Coverage requires members to have type 2 diabetes AND have tried or be unable to use generic sitagliptin/metformin ER. The policy excludes members with a history of pancreatitis.

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What to do

by Dec 15, 2026 · 6 steps
01Billing team and providers must implement prior authorization requirement for all Janumet XR prescriptions for Humana Medicare Advantage members.
02Update billing system to flag Janumet XR claims requiring prior auth approval before submission.
03Create/update clinical documentation requirements in EMR to capture: (a) documented type 2 diabetes diagnosis, (b) evidence member has tried generic sitagliptin/metformin ER OR medical reason unable to use generic formulation, (c) confirmation member does NOT have history of pancreatitis.
04Front desk and clinical staff must verify prior auth status before dispensing.
05Direct all prescribers to submit prior auth requests through Humana's PAL system (www.humana.com/PAL) with supporting clinical documentation.
06Consequence: Claims submitted without prior authorization will be denied for Humana Medicare Advantage members.

Original notice

Janumet XR (sitagliptin and metformin hydrochloride extended-release) (New)
mcp.humana.com · Always check the source before changing claims.
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Related changes

See all Humana changes →
Janumet (sitagliptin and metformin hydrochloride) (New)HighEffective Jan 1, 2027 · Medicare AdvantageBrowse every Humana change in the policy list

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Humana policiesEndocrinologyInternal MedicineFamily MedicinePharmacy

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