Medicare AdvantagePrior AuthMedium impact
Juxtapid® (lomitapide) (Revised)
Humana·Cardiology, Endocrinology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 22, 2026
Summary
Humana revised its Juxtapid (lomitapide) prior authorization policy for Medicare Advantage members with homozygous familial hypercholesterolemia (HoFH). The policy requires prior authorization and mandates that members must have failed, been intolerant to, or have contraindications to Repatha (evolocumab) before Juxtapid approval. Additionally, members must document initiation of a low-fat diet (<20% fat) and specific vitamin/fatty acid supplementation (vitamin E, linoleic acid, omega-3 fatty acids) prior to starting treatment.
Action Required
Before January 1, 2026: Billing and clinical staff must implement prior authorization requirements for all Juxtapid (lomitapide) requests for Medicare Advantage members. 1) Update prior authorization system to require: (a) Genetic confirmation of HoFH OR untreated LDL-C >400 mg/dL with clinical evidence; (b) Documentation of prior Repatha (evolocumab) treatment/intolerance/contraindication; (c) Evidence of low-fat diet initiation (<20% fat) and vitamin E, linoleic acid, and omega-3 supplementation (ALA, EPA, DHA) prior to Juxtapid start. 2) Modify encounter templates and prior auth request forms to collect required clinical documentation. 3) Train providers and billing staff on the three mandatory criteria for approval. 4) Notify prescribers that Juxtapid claims without complete prior authorization documentation will be denied. Note: The policy revision date is July 22, 2026, which post-dates the effective date; verify with Humana for any interim updates.