MedicaidPrior AuthLow impact
Brineura™ (cerliponase alfa) (New)
Humana·OH · Neurology, Pediatrics·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Brineura (cerliponase alfa), a specialized treatment for CLN2 disease in pediatric patients. This rare neurological condition requires specific diagnostic criteria and physician expertise for approval.
Action Required
By June 1, 2026: Billing team must update prior authorization protocols for Brineura (cerliponase alfa) for Ohio Medicaid patients. Ensure providers document TPP1 deficiency testing, CLN2 Clinical Rating Scale scores of 3 or higher, and physician qualifications for intraventricular administration. Visit www.humana.com/PAL for specific medical and procedural coding requirements before submitting claims.