MedicaidPrior AuthLow impact
Crysvita® (burosumab) (New)
Humana·OH · Endocrinology, Pediatrics, Nephrology +1 more·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Crysvita (burosumab), a specialty medication used to treat X-linked hypophosphatemia and tumor-induced osteomalacia. Prior authorization will be required for all Crysvita prescriptions with specific diagnostic and lab value criteria that must be met.
Action Required
By May 1, 2026: Billing and clinical teams must implement prior authorization requirements for all Crysvita (burosumab) prescriptions for Humana Medicaid Ohio patients. Ensure providers document required lab values (FGF23 >30 pg/mL, reduced TmP/GFR ratio) and clinical symptoms before prescribing. Update EMR templates to capture required diagnostic criteria. Claims will be denied without proper prior authorization.