MedicaidPrior AuthLow impact
Nexviazyme™ (avalglucosidase alfa-ngpt) Injection (New)
Humana·OH · Neurology, Genetics, Pediatrics·Medicaid
Effective date
May 27, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Nexviazyme (avalglucosidase alfa-ngpt) injection, used to treat late-onset Pompe disease. Prior authorization will be required with specific diagnostic and testing criteria before coverage is approved.
Action Required
By May 27, 2026: Billing team must ensure prior authorization is obtained from Humana before administering Nexviazyme injections to Ohio Medicaid patients. Verify patient has confirmed late-onset Pompe disease diagnosis with supporting lab/genetic testing showing GAA enzyme deficiency or pathogenic GAA gene variants. Visit www.humana.com/PAL for specific medical billing codes and preauthorization requirements.