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SGLT2 Inhibitors (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 SGLT2 Inhibitors effective January 1, 2027, affecting Medicare Advantage members. The policy requires prior auth for six SGLT2 inhibitor medications (Steglatro, Segluromet, Invokana, Invokamet, Invokamet XR, Synjardy, Synjardy XR) and mandates that members have Type 2 diabetes AND have tried or cannot take empagliflozin or dapagliflozin-containing medications before approval.
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What to do
by Dec 31, 2026 · 6 steps
01Billing team must implement prior authorization requirements for all SGLT2 inhibitor prescriptions in the pharmacy billing system for Medicare Advantage plans.
02Update pharmacy claims processing workflow to require verification that members meet both criteria: (1) Type 2 diabetes diagnosis, and (2) documented trial of or contraindication to empagliflozin AND dapagliflozin before processing claims for Steglatro, Segluromet, Invokana, Invokamet, Invokamet XR, Synjardy, or Synjardy XR.
03Coordinate with prescribing providers to ensure documentation of empagliflozin and dapagliflozin trial status is available for prior authorization submissions.
04Configure system to obtain prior auth before claims are submitted.
05Update pharmacy staff protocols and provider communications.
06Claims submitted without prior authorization will be denied for Medicare Advantage members effective January 1, 2027.
Original notice
SGLT2 Inhibitors (New)
mcp.humana.com · Always check the source before changing claims.