MedicaidPrior AuthMedium impact
Fabrazyme® (agalsidase beta) and Elfabrio® (pegunigalsidase alfa) (New)
Humana·OH · Genetics, Nephrology, Cardiology +1 more·Medicaid
Effective date
Feb 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has implemented a new prior authorization policy for Fabrazyme (agalsidase beta) and Elfabrio (pegunigalsidase alfa) treatments for Fabry Disease. Prior authorization is now required for both IV solutions with documented diagnosis being the primary criteria.
Action Required
Before February 1, 2026: Billing team must implement prior authorization requirements for Fabrazyme and Elfabrio IV solutions for Humana Medicaid Ohio members. Update billing system to flag these medications and ensure providers obtain prior auth by documenting confirmed Fabry Disease diagnosis. Visit www.humana.com/PAL for medical and procedural coding information. Claims without prior authorization will be denied.