Medicare AdvantagePrior AuthLow impact
Avlayah™ (tividenofusp alfa-eknm) solution (New)
Humana·KY, SC, VA · Pediatrics, Genetics, Neurology·Medicaid
Effective date
May 27, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Avlayah (tividenofusp alfa-eknm), a specialized enzyme replacement therapy for treating neurologic manifestations of Hunter syndrome in pediatric patients weighing at least 5 kg. This policy requires prior authorization approval for Medicare and Medicaid patients in Kentucky, South Carolina, and Virginia.
Action Required
By May 27, 2026: Billing team must implement prior authorization requirements for Avlayah (tividenofusp alfa-eknm) infusions for Humana Medicare and Medicaid patients in Kentucky, South Carolina, and Virginia. Update billing system to flag these claims and ensure providers obtain approval before treatment initiation. For medical billing codes, reference www.humana.com/PAL for specific CPT/HCPCS requirements.