MedicaidPrior AuthLow impact
Itvisma (onasemnogene Abeparvovec-brve) (New)
Humana·LA · Neurology, Genetics, Pediatrics·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Louisiana has established a new prior authorization policy for Itvisma (onasemnogene abeparvovec-brve), a gene therapy for spinal muscular atrophy in patients 2 years and older. This is a single lifetime dose treatment requiring strict eligibility criteria including genetic confirmation, antibody titers, and specialist oversight.
Action Required
Before March 1, 2026: Billing team must update prior authorization requirements for Itvisma (onasemnogene abeparvovec-brve) claims. Ensure all 7 eligibility criteria are documented including genetic confirmation of SMN1 mutation, patient age 2+ years, anti-AAV9 antibody titers ≤1:50, and treatment by SMA specialist. Visit www.humana.com/PAL for specific medical billing codes. Claims without proper prior authorization will be denied.