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

Januvia (sitagliptin) (New)

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026

Summary

Humana has implemented a NEW prior authorization policy for Januvia (sitagliptin) effective January 1, 2027, for Medicare Advantage members with type 2 diabetes. Coverage requires members to have tried or be unable to use generic sitagliptin first, and prior authorization is mandatory for all brand-name Januvia prescriptions.

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What to do

by Dec 31, 2026 · 6 steps
01Billing team must implement prior authorization workflow for all Januvia (sitagliptin) prescriptions on Humana Medicare Advantage plans.
02Update billing system to flag Januvia claims requiring prior auth submission before processing.
03Providers must document in claims that member has tried generic sitagliptin or cannot use it due to medical necessity.
04Contact Humana's PAL (Preauthorization and Notification List) system at www.humana.com/PAL for specific medical coding requirements.
05Failure to obtain prior authorization will result in claim denials.
06Front desk staff should alert providers that generic sitagliptin must be tried first or contraindicated before brand Januvia will be approved.

Original notice

Januvia (sitagliptin) (New)
mcp.humana.com · Always check the source before changing claims.
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Humana policiesEndocrinologyInternal MedicineFamily MedicineGeneral Practice

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