Medicare AdvantagePrior AuthMedium impact
Lynavoy (linerixibat) (New)
Humana·Gastroenterology, Internal Medicine·Medicare Advantage
Effective date
Jul 22, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicare Advantage has established a new prior authorization policy for Lynavoy (linerixibat), effective July 22, 2026. The drug is approved only for patients with primary biliary cholangitis (PBC) experiencing moderate to severe cholestatic pruritus who are stable on maintenance PBC therapy and have failed or cannot tolerate at least two alternative treatments (cholestyramine, rifampin, or naltrexone). Claims must meet all five clinical criteria or they will be denied.
Action Required
By July 22, 2026: Billing and clinical staff must implement prior authorization requirements for Lynavoy (linerixibat) in the billing system. Before submitting any Lynavoy claims for Medicare Advantage members, verify: (1) documented PBC diagnosis, (2) moderate to severe cholestatic pruritus confirmation, (3) current maintenance therapy documentation (UDCA or PPAR agonists), (4) absence of hepatic decompensation or prior decompensation events, and (5) documented trial or contraindication for at least two of the following: cholestyramine, rifampin, or naltrexone. Route all Lynavoy claims through the Humana Prior Authorization portal (www.humana.com/PAL) before dispensing. Update clinical workflow and provider templates to include pruritus severity assessment and alternative treatment history documentation. Failure to obtain prior authorization will result in claim denials and potential member balance billing.