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Trijardy XR (empagliflozin, linagliptin, and metformin hydrochloride extended release) (New)
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Oct 15, 2026
Summary
Humana is implementing a new prior authorization pharmacy coverage policy for Trijardy XR (a fixed-dose combination of empagliflozin, linagliptin, and metformin) effective January 1, 2027. The policy requires prior authorization for Medicare Advantage members with type 2 diabetes who have tried or cannot take individual DPP-4 inhibitors, SGLT2 inhibitors, and metformin before approval.
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What to do
by Jan 1, 2027 · 5 steps
01Billing and pharmacy teams must implement prior authorization requirements for Trijardy XR (empagliflozin/linagliptin/metformin extended-release tablets) for all Medicare Advantage members.
02Update billing software and pharmacy systems to require documentation that members have tried or cannot take: (1) sitagliptin OR linagliptin, AND (2) empagliflozin OR dapagliflozin, AND (3) metformin.
03Prior authorization approval is valid for the initial plan year.
04Claims submitted without required prior authorization documentation will be subject to denial under Humana Medicare Advantage plans.
05Verify current applicability with Humana's online policy portal before processing claims, as this document carries a disclaimer that printed versions become uncontrolled.
Original notice
Trijardy XR (empagliflozin, linagliptin, and metformin hydrochloride extended release) (New)
mcp.humana.com · Always check the source before changing claims.