MedicaidPrior AuthMedium impact
Saphnelo™ (anifrolumab-fnia) (New)
Humana·KY, SC · Rheumatology, Internal Medicine·Medicaid
Effective date
May 27, 2026
We identified it
Jun 24, 2026
Summary
Humana has implemented a new prior authorization policy for Saphnelo (anifrolumab-fnia), an IV treatment for moderate to severe systemic lupus erythematosus. The policy requires specific diagnostic criteria, autoantibody testing, and combination with standard treatments for Medicaid patients in Kentucky and South Carolina.
Action Required
By May 27, 2026: Billing team must update prior authorization requirements for Saphnelo (anifrolumab-fnia) in billing system for Kentucky and South Carolina Medicaid patients. Ensure providers document: 1) moderate to severe SLE diagnosis, 2) positive autoantibodies (ANA, anti-ds DNA, anti-Sm), 3) use with standard treatments, 4) absence of severe lupus nephritis/nervous system involvement, and 5) prescriber expertise in SLE treatment. Claims will require prior auth approval before administration.