MedicaidPrior AuthLow impact
Crysvita® (burosumab) (New)
Humana·IN · Endocrinology, Pediatrics, Rheumatology +1 more·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Indiana has implemented a new prior authorization policy for Crysvita® (burosumab), a specialized medication for treating X-Linked Hypophosphatemia (XLH) and Tumor-Induced Osteomalacia (TIO). This requires specific diagnostic criteria including FGF23 levels >30 pg/mL and clinical symptoms before approval.
Action Required
Before May 1, 2026: Billing team must update prior authorization processes for Crysvita® (burosumab) prescriptions for Indiana Medicaid patients. Ensure providers document FGF23 levels >30 pg/mL, TmP/GFR ratios, and clinical symptoms (rickets, growth impairment, muscle weakness) before submitting prior auth requests. Visit www.humana.com/PAL for specific medical coding information. Claims without proper prior authorization will be denied.