MedicaidPrior AuthMedium impact
Spinraza® (nusinersen) (New)
Humana·OH · Neurology, Pediatrics·Medicaid
Effective date
Mar 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Spinraza (nusinersen), a specialized intrathecal treatment for Spinal Muscular Atrophy. The policy requires extensive documentation including genetic testing, functional assessments, and specialist consultation before coverage approval.
Action Required
By March 1, 2026: Billing team must implement prior authorization requirements for Spinraza (nusinersen) for Ohio Medicaid patients. Ensure providers obtain genetic testing documentation, baseline functional assessments (HFMSE, HINE, ULM, CHOP INTEND, or MFM32), and specialist consultation before administration. Update billing system to flag these requirements. Claims will be denied without proper prior authorization.