MedicaidPrior AuthLow impact
Onpattro® (patisiran) (New)
Humana·OH · Neurology, Genetics, Internal Medicine·Medicaid
Effective date
Jun 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization requirement for Onpattro (patisiran), a specialized IV medication for hereditary transthyretin-mediated amyloidosis with polyneuropathy. Authorization requires genetic testing documentation, neurologic examination, disability scoring, and confirmation of no prior liver transplant.
Action Required
Before June 1, 2026: Billing team must implement prior authorization requirements for Onpattro (patisiran) for Ohio Medicaid patients. Providers must document TTR gene mutation, comprehensive neurologic examination ruling out other causes, polyneuropathy disability score of IIIb or lower, and confirm no previous liver transplant. Visit www.humana.com/PAL for medical and procedural coding information. Claims will be denied without proper prior authorization.